你好，我是博士。麦克·她在该部门 hello I'm dr. Mike she in the Department
物理学的反应kaiser永久 of Physics react kaiser permanente this
视频将为您提供关键信息 video will give you key information
关于如何从腰痛中治愈 about how to heal from your back pain
首先让我们找出一些红色 first of all let's identify some red
标志这些是迹象表明 flags these are signs that something
可能会更严重 more serious might be going on
无法解释的减肥原因不明 unexplained weight loss unexplained
发烧发冷或盗汗个人 fevers chills or night sweats a personal
癌症史重大损失 history of cancer the significant loss
一只或两只腿的力量下降 of strength in one or both legs loss of
感觉越来越差 feeling that is getting steadily worse
持有或释放的新困难 new difficulty in holding or releasing
您的尿液或大便疼痛 your urine or stool pain that has
持续恶化超过三个 steadily worsened for more than three
几个月的严重创伤，例如 months significant trauma such as
摔在屁股上或变得僵硬 falling hard on your buttock or getting
出车祸，新的背痛同时 into a car accident new back pain while
服用泼尼松等口服类固醇或 taking oral steroids like prednisone or
地塞米松已有七十多年的历史了 dexamethasone more than seventy years of
伴有新的背痛的年龄 age with new back pain pain while
睡觉比其他任何人都差 sleeping that is worse than any other
白天的时间（如果有） time during the day if you have any of
这些请咨询您的初级保健 these please consult your primary care
提供者立即提供您 provider immediately provided that you
没有任何危险信号，让我们开始 do not have any red flags let's start
有两个带回家的积分第一 with two take-home points number one
没有什么大不了的 there is nothing seriously wrong with
你的背部 your back
你很少有 it is very very unlikely that you have
任何严重的神经损伤，骨折，癌症 any serious nerve damage fracture cancer
感染或任何其他潜在疾病 infection or any other underlying
第二种疾病 disease number two most of your back
疼痛由您控制，其中包括 pain is under your control this includes
具体练习正确姿势好 specific exercises correct posture good
睡适量的运动 sleep a moderate amount of movement and
您可能会保持健康的态度 a healthy attitude you might be
想知道是否没有什么是认真的 wondering well if nothing is seriously
我的背错了，那我为什么受伤 wrong with my back then why do I hurt
答案是两者的结合 the answer is a combination of two
影响诸如骨头等组织 factors the tissues such as the bones
关节韧带和椎间盘 the joints the ligaments and the discs
和你的大脑让我们看看 and your brain let's look at what
在正常情况下发生在组织上 happens to the tissues during the normal
健康的衰老过程首先是光盘 healthy aging process first the discs
开始干the光盘就像果冻一样 begin to dry up the disc is like a jelly
骨头之间填充了减震器 filled shock absorber between the bones
脊柱的 of the spine
当我们将果冻中的液体老化时 as we age the liquid from the jelly
渗入盘的外部纤维 seeps into the outer fibers of the disk
纤维开始变弱和隆起， the fibers start to weaken and bulge and
果冻开始消失，这是 the jelly starts to disappear this is
为什么我们通常开始收缩 why we normally begin to shrink in
在30年代后期达到最高身高，大约损失2 height in our late 30s and lose about 2
英寸，直到我们终于70岁 inches by the time we're 70 finally
因为减震少 because there is less shock absorption
骨头变得更宽，吸收更多 that bone grows broader to absorb more
产生椎骨压力 pressure resulting in vertebral bone
刺激此过程的名称是 spurs the name for this process is
退行性疾病这种疾病 degenerative this disease which simply
表示光盘正常老化，并且 means normal aging of the discs and
通常不会引起任何其他痛苦 often does not cause any pain another
之所以开始发生是因为 thing that starts to happen is because
风筝的损失在关节 of the loss of this kite the joints in
脊柱的背面称为刻面 the back of the spine called facet
关节开始越来越感觉 joints start feeling more and more
压力，所以他们会发展骨刺 pressure and so they develop bone spurs
也叫做小关节 as well this is called facet joint
关节病或小关节肥大 arthropathy or facet joint hypertrophy
这些都是老龄化的正常特征 again these are normal features of Aging
而且通常不会引起疼痛，怎么办 and often do not cause pain so how can
所有这些事情都发生在脊柱上 all these things happen to the spine
不会在广阔的地方造成痛苦 without causing pain in the vast
大多数情况下的原因是因为 majority of cases the reason is because
这些事情正在慢慢发生 while these things are slowly happening
到大脑能够组织的组织 to the tissues that brain is able to
适应良好的睡眠习惯 adapt things like good sleep regular
运动和积极的态度有助于 movement and a positive attitude helps
大脑适应这些变化 the brain adapt to these changes
想像一个16岁的孩子 imagine a 16 year old kid who's never
曾经有过背痛或关节痛 had back pain or joint pain ever before
然后考虑一个50岁的正常人 then consider a normal 50 year old who
已经有一些与年龄有关的 already has some of these age-related
脊椎改变但也没有 changes in their spine but also doesn't
现在有任何重大的痛苦想象 have any significant pain now imagine
那个16岁的孩子有一天醒来 that one day the 16 year old kid wakes
突然在50岁的老人身上 up in the 50 year olds body suddenly he
会伤到整个地方 would hurt all over the place this is
因为他的大脑没有那30个 because his brain didn't have those 30
奇数年适应缓慢和 odd years to adapt to the slow and
身体发生的稳定变化 steady changes that happen to the body
大脑是一个神奇的器官 the brain is an amazing organ that
非常适应新信息 adapts to new information extremely
快速但为了学习和适应 quickly but in order to learn and adapt
很好，我们需要新信息 well to new information we need good
睡眠规律的运动和积极的 sleep regular exercise and a positive
态度就像孩子们需要的 attitude just like what kids need to
只要我们付出 excel in school as long as we give our
尽我们所能，这些关键成分 brains these key ingredients we can
适应正常年龄 adapt to the normal age
处理并消除信号 process and extinguish the signals
从我们后面回来这就是为什么 coming from our back this is why the
绝大多数人 vast majority of people with
椎间盘退变性疾病或小关节 degenerative disc disease or facet joint
肥大没有回任何经历 hypertrophy do not experience any back
疼痛，所以我们看了正常情况 pain so we looked at what normally
随着年龄的增长，脊椎也会发生变化 happens to our spines as we age and how
我们的大脑适应了这个过程 our brain adapts to this process to
预防疼痛我们什么时候有 prevent pain what about when we do have
背痛首先发生了什么 back pain what's going on there first
让我们看看在什么地方会出问题 let's look at what can go wrong in the
脊椎组织记住椎间盘 tissues of the spine remember the disk
充满西式的果冻 that's filled with jelly in Western
社会，我们花费了大量时间 society we spend a great deal of time
坐在零和 sitting bending forward between zero and
90度或用手抬起远 90 degrees or lifting with our hands far
相反地​​，我们不会 out in front of us conversely we don't
花几乎所有的时间去散步 spend nearly as much time walking
向后弯曲或抬头看着 bending backwards or looking up at the
结果像我们祖先的天空 sky like our ancestors did as a result
我们最终对自己施加了太大压力 we end up putting too much pressure on
光盘推果冻的前部 the front of the disc shoving jelly
随着时间流向光盘背面 towards the back of the disc over time
果冻削弱了背部纤维， the jelly weakens those back fibers and
不需要多少，但最后一根稻草 it doesn't take much but the last straw
可以这么说，在骆驼的背上 on the camel's back so to speak and some
这个果冻突然冒出来 of that this jelly pops through
导致磁盘撕裂并可能 resulting in a disk tear and potentially
椎间盘突出症通常是 a disc herniation this is usually
典型场景非常痛苦 intensely painful the typical scenario
你会弯腰捡东西吗 would be you bend over to pick something
离开地板甚至可能是纸 off the floor it could even be a paper
夹子或铅笔和笔杆，您在 clip or a pencil and bam you're in the
您曾经无法承受的最严重的痛苦 worst pain you've ever had unable to
甚至由于严重的背痛而移动，如果 even move due to severe back pain if the
突出的果冻刺激神经 herniated jelly irritates a nerve the
疼痛可能扩散到臀部或腿部 pain may radiate into the buttock or leg
导致我们称之为坐骨神经痛 resulting in what we call sciatica the
在这种情况下要做的第一件事是 first thing to do in this situation is
像你一样把尽可能多的果冻推回去 to push as much jelly back inside as you
可以并关闭光盘撕裂让它 can and to close the disc tear to let it
如果您有两个或多个 heal now if you have two or more of
这些症状 these symptoms
光盘仍然有机会打开 chances are the disc tere is still open
痛苦是最糟糕的第一件事 the pain is worse first thing in the
早晨，疼痛甚至加重 morning the pain is worse with even the
轻微弯曲 slightest bending like bending over the
下沉咳嗽或打喷嚏使疼痛 sink coughing or sneezing makes the pain
差很多 a lot worse
如果这种情况下坐着很痛苦 sitting is very painful if this scenario
然后很像你的情况 closely resembles your situation then
点击此链接以获取具体信息 click on this link for specific
有关如何操作的说明 instructions on how to
即使恢复也很快恢复 recover quickly even after recovering
从这样的情节中有一些 from an episode like this there are some
磁盘剩余变化 residual changes that make the disk more
容易再次受伤 vulnerable to being injured again first
即使在眼泪治愈之后 of all even after the tear has healed
果冻仍然靠近 the jelly is still sitting close to the
磁盘的后边缘第二 back edge of the disk secondly the
脊柱受伤的部分现在是 injured segment of the spine is now the
脊柱最薄弱的部分 weakest part of the spine like a coat
中间弯曲的衣架 hanger that's been bent in the middle
它更有可能继续屈曲 it's more likely to keep buckling at
那个弱点，如果你最近 that weak spot if you've recently
从背痛发作中恢复 recovered from an episode of back pain
或者如果您倾向于经常重复 or if you tend to get frequent repeated
严重的背痛发作请点击 episodes of severe back pain click on
此链接的具体说明 this link for specific instructions on
如何防止这种情况再次发生 how to prevent this from happening again
最后如果有一两个光盘 finally if there are one or two discs
损失了很多 that have lost a significant amount of
果冻关节炎可以在早期 jelly arthritis can set in early in the
相应的小关节 corresponding facet joints which in some
病例可能会引起腰痛，如果 cases can cause back pain if the
小关节和韧带长满 overgrown facet joints and ligaments
侵蚀神经的压力 encroach upon the nerves the pressure on
神经有时会引起疼痛 the nerves can sometimes cause pain as
在这些情况下感觉很好 well in these cases the pain feels
坐下来更好 better when sitting down but then
因为臀部坐得过多 because of excessive sitting the hip
屈肌紧绷并拉 flexor muscles get tight and pull the
脊椎向前弯曲 spine into a forward bent position
引起背部肌肉拉伤 causing strain on the back muscles in
这些情况下，疼痛通常会加重 these cases the pain is typically worse
你脚踩得越久痛苦 the longer you are on your feet the pain
站起来时可能会更糟 can be worse when standing up from a
坐姿疼痛感觉好些 seated position the pain feels better
当倚在购物车或 when leaning over a shopping cart or a
沃克的痛苦很快得到缓解 walker the pain is quickly relieved when
如果这种情况，请坐下 sitting back down if this scenario
然后很像你的情况 closely resembles your situation then
点击此链接以获取具体信息 click on this link for specific
有关如何自然管理的说明 instructions on how to naturally manage
现在不管这个痛苦 this pain now regardless of which of
这些情况最适合您的痛苦 these situations fits your pain the best
或即使这三种情况都没有 or even if none of these three scenarios
描述你的情况你仍然可以 describes your situation you can still
受益于以下建议，避免 benefit from the following advice avoid
长时间坐着或站着改变 prolonged sitting or standing change
至少每30分钟定位一次 positions at least every 30 minutes
不管你坐着还是 regardless of whether you're sitting or
站在你的耳垂 standing your earlobes should be
正好在你的肩膀上 directly above your shoulders your
肩膀正好在您的臀部上方 shoulders directly above your hips and
你的眼睛应该与 your eyes should be level with an
假想线的三分之一 imaginary line a third of the way down
从计算机屏幕的顶部 from the top of your computer screen
有时候跪椅更好 sometimes the kneeling chair is better
对于那些带有敏感光盘的人 for those with sensitive discs when
然后举起一些东西在膝盖上 lifting something then at the knees and
臀部不在脊柱处， hips not at the spine and carry the
物体尽可能靠近你的腰部 object as close to your waist as
可能伸展你的髋屈肌和 possible stretch your hip flexors and
这些链接中显示的绳肌 your hamstrings as shown in these links
这样你的双腿就不太可能 this way your legs are less likely to
弯曲你的脊椎，继续前进 crank on your spine keep moving a
合理的目标是采取10,000步 reasonable goal is to take 10,000 steps
一天，不管出什么问题 a day regardless of what the problem is
用你的脊椎，你的脊椎需要一个 with your spine your spine needs a
每天运动量适中 moderate amount of movement every day to
保持健康，所以我们花了很多时间 stay healthy so we spent a whole lot of
时间在谈论组织什么 time talking about the tissues what
关于大脑的研究表明 about the brain research shows that the
以下因素阻碍了 following factors get in the way of
否则可以克服背痛麻醉药 overcoming back pain narcotics otherwise
被称为鸦片或阿片类药物 known as opiates or opioids these are
诺科维柯丁泰诺尔等药物 medications like Norco vicodin tylenol
与可待因percocet吗啡羟考酮 with codeine percocet morphine oxycodone
双月阿米斯·康和奥昔康这些 dilaudid amis Contin and oxycontin these
药物可以防止大脑 medications prevent the brain from
自然地适应痛苦，所以在 naturally adapting to the pain so in the
从长远来看，你最终会比 long run you end up with more pain than
如果您只是避免使用这些药物 if you simply avoided these medications
完全负压力之一 altogether negative stress one of the
大脑最重要的原因 most important reasons why the brain
无法适应是因为来自 doesn't adapt is because of stress from
在工作或家里的人际关系 one's relationships at work or at home
特别是如果你一直在 particularly if you are constantly being
放慢睡眠需要大脑 put down poor sleep the brain needs
宁静的睡眠以适应新情况 restful sleep to adapt to new situations
背痛也不例外 and back pain is no exception
不幸的是苯二氮卓类助睡眠剂 unfortunately benzodiazepines sleep aids
例如xanax valium和klonopin such as xanax valium and klonopin along
与前面提到的麻醉品 with the previously mentioned narcotics
实际上阻​​止了大脑 actually prevent the brain from getting
宁静的睡眠关于不正确的信念 restful sleep incorrect beliefs about
疼痛有三点特别有害 pain there are three especially damaging
阻止大脑发生的信念 beliefs that prevent the brain from
适应第一是灾难性的 adapting the first is catastrophizing
这就是必须 this is the idea that something must be
你的背非常严重，因为 terribly wrong with your back because
你伤得太多了，或者那只是快要发生了 you hurt so much or that is just going
越来越害怕运动 to get worse and worse fear of movement
运动对于克服至关重要 movement is essential for overcoming
背痛，因为它刺激您 back pain because it stimulates your
大脑创造新途径 brain to create new pathway
并在恐惧中学习如何适应 and learn how to adapt if you're afraid
动作会使你更加痛苦 that movement will cause you more pain
你会剥夺你的大脑 you will deprive your brain of the
克服你的必要刺激 necessary stimulation to overcome your
疼痛的感觉像是痛苦已经过去了 pain feeling like the pain is out of
你控制什么都没有 your control that there's nothing you
可能可以自己做以帮助您 can possibly do on your own to help your
痛苦，那么您该怎么做才能优化自己 pain so what can you do to optimize your
大脑克服背痛的能力 brain's ability to overcome back pain
避免麻醉药品和苯二氮卓类药物 avoid narcotics and benzodiazepines
解决您遇到的任何情况 address any situations where you're
不断被放下或被欺负 constantly being put down or bullied
有时离开是唯一的选择 sometimes leaving is the only option
遵循良好的睡眠习惯先尝试 follow a good sleep habits first try
这些简单的东西如果不起作用 these simple things if they don't work
向您的医生询问加巴喷丁或 ask your doctor about gabapentin or
曲扎酮或尝试草药，例如 trazadone or try herbal remedies such as
褪黑素或缬草根提醒 melatonin or valerian root remind
数百万人拥有的自己 yourself that millions of people have
成功克服腰痛 successfully overcome back pain and with
在此信息的帮助 the help of the information in this
视频，这样您可以让您的身体移动吗？ video so can you let your body move a
合理的目标是每天10,000步 reasonable goal is 10,000 steps a day
这将使您的大脑足够 this will give your brain enough
刺激，使其知道如何 stimulation so that it knows how to
适应脊椎的变化吧 adapt to the changes in your spine it
可能需要数周或数月的时间才能完成此操作 may take weeks or months to get to this
目标，但你可以做到 goal but you can do it
最后，让我们回顾一下主要内容 finally let's review the main take-home
这个视频的第一点是 points of this video number one there is
背部没有严重毛病 nothing seriously wrong with your back
只要你没有红色 as long as you don't have any of the red
在开头提到的标志 flags mentioned at the beginning of the
视频，您非常不可能 video it's very very unlikely that you
有任何神经损伤骨折癌 have any nerve damage fracture cancer
感染或任何其他潜在疾病 infection or any other underlying
第二种疾病 disease number two most of your back
疼痛由您控制，其中包括 pain is under your control this includes
具体练习正确姿势好 specific exercises correct posture good
睡适量的运动 sleep a moderate amount of movement and
健康的态度谢谢你 a healthy attitude thank you for
听着，如果你发现了这个 listening and if you found this
有用的信息，请与他人分享 information helpful please share with
其他 others
照顾自己 take care