When can I sit after removing hemorrhoids. Principles of management of the postoperative period after plastic vaginal surgeries

2-3 months after surgery:



The period of outpatient treatment ends and it's time to go to work. Before going to work, you need to come for a consultation with a vertebrologist, orthopedist. It is advisable to do an MRI and a study of the biomechanics of the spine, which will help the doctor to objectively assess the effectiveness of surgical treatment and develop recommendations for preventing the progression of spinal disease.

Sitting is allowed 1 month after surgery. Remember that it is important not only how much, but also how to sit. We repeat once again: in a sitting position, it is necessary to maintain the shape of the spine with a forward bend in the lumbar region and. For sitting, it is better to use a chair with a small seat and a pronounced support under the lower back (computer chair), the height of the chair is such that the knees are lower than the hip joints. We sit on a chair and rest our hands on our knees or on the arms of the chair. When sitting, we shift the buttocks as far back as possible, so that the back of the office chair rests against the lower back (the difference between the office chair and the director's chair is the presence of a gap between the back and the seat, often even the metal holder of the back is bent in this place) with insufficient support under the lower back, put a pillow. We keep this position, with the most straightened back and the deflection of the lumbar forward, for the entire period of sitting. When standing up, do not bend the spine, but move to the edge of the chair and stand with your legs up, and not forward, preferably with your hands resting on your knees or in the arms of the chair.

You can drive a car in 1.5-2 months. If your journey to work by car is more than 1 hour, then you need to take breaks. Stop, take your time, get out of the car, just walk around and do some warm-up exercises with backbends to the sides, do a few squats with a straight back - “on toes”. Traveling by public transport is fraught with another danger, uncontrolled movements, so a corset for the duration of the journey is a must.

During the first months after returning to work, you should not engage in heavy physical labor (lifting weights, digging the ground, etc.). You can apply this calculation: a month after the operation, you can lift 1 kg for each arm, every month it is allowed to add 1 kg for each arm. But remember, and in the future, try to follow the rules of the safety instructions for movers, which determines that when carrying heavy loads, the maximum permissible load is: for male adolescents from 16 to 18 years old - 16 kg; for men - 50 kg. For women - 10 kg, up to two times per hour, when alternating with other work and 7 kg - when lifting weights constantly during the work shift. Since 2008, the maximum weight allowed to be lifted by airline loaders in the United States has been limited to 35 kg, while a semi-rigid corset is part of the loader's mandatory overalls.

All this knowledge of correct behavior, movements, work had to be applied from childhood in order to prevent the formation of a hernia, but if everything happened, now apply this knowledge to prevent new exacerbations.

It is not enough just to operate on a herniated disc in the lumbar spine. Although the operation itself is quite complicated, rehabilitation after removal of the intervertebral hernia is no less important. The task is big, because it is necessary to return the patient the ability to move normally without pain and neurological symptoms. Muscle tone is restored - and the person returns to his usual way of life.

It is difficult to say how long the rehabilitation period lasts, because the recovery period depends on the joint efforts of the doctor and the patient himself. Only an integrated approach after the operation will help you to feel the result as much as possible. How does the rehabilitation period after recovery proceed, we will try to figure it out. It has its own peculiarities and subtleties that will allow you to achieve the maximum possible success after a successful operation.

Recovery steps

Doctors divide the recovery period into early, late and remote. Each has its own specificity, which flows smoothly into the next stage. The early one does not last long - from about a week to two after the operation. The late takes over in the third week and lasts approximately two months. Remote begins after the eighth week and lasts throughout the rest of life. It does not matter in which area the disc herniation was removed, the rehabilitation period will proceed in the same way.

What is the rehabilitation period

In general, rehabilitation after removal of a herniated disc of the lumbar spine is a set of special events, exercises, procedures that are prescribed to a person after the operation and are mandatory for the patient. The duration is determined by the doctor depending on the complexity of the operation, the course of the recovery period after it. A person needs to be monitored by doctors of various specialties, the list includes a neurosurgeon who operated on the patient, a rehabilitation specialist and, if necessary, a neuropathologist. As necessary, the list can be supplemented by other specialists.

It is mandatory to prescribe medications that are not only able to prevent possible complications, but also reduce the manifestation of pain. Rehabilitation after removal of an intervertebral hernia is supplemented by a complex of physiotherapy and therapeutic exercises. It allows you to make the muscles stronger and tone them after the operation, so they are more prepared for further stress.

Everything ends with a sanatorium treatment, where there is special equipment, personnel and best practices for the restoration of a person in the postoperative period. However, there are some limitations at each stage.

What should be limited

In the early postoperative period it is strictly forbidden:

Sitting position. This also applies to transportation.

Lift weights. The maximum allowed weight is no more than 3 kilograms.

Move without a special corset. Twisting and sharp movements are completely excluded.

Any physical activity is excluded without the recommendation of the attending physician.

Any manual therapy is contraindicated.


You need to completely abandon bad habits and follow a diet that allows you to control weight.

In the later period, there are certain limitations. The list of what is prohibited can be presented as follows:

  • it is not recommended to stay in a stable position for a long time;
  • without a preliminary warm-up of the muscles, any, even the most insignificant load, is completely excluded;
  • shaking and long-term movement in public transport are excluded;
  • lifting more than 5 or 8 kilograms (at the discretion of the specialist);
  • you need to walk in a corset for at least 3-4 hours during the day.

You need to carefully monitor the weight, and every 3 or 4 hours you need to take a horizontal position in order to fully rest for 20 minutes. The pain after the operation disappears, but it is worth breaking the restriction regime, and it will return again.

In the delayed period, the list of restrictions is narrowed, but you still should not relax. In each case, the specialist gives his recommendations on how to live on.

Medicines

When a herniated disc of the lumbar spine is removed, pain occurs against the background of the operation performed. During this period, non-steroidal anti-inflammatory drugs (NSAIDs) are prescribed. To improve blood flow, vascular preparations are used, as well as those that enhance microcirculation. Additionally, chondroprotectors are used to restore cartilage. But you need to take them for a long time to feel the effect.

For nervous tissue and, in fact, roots, vitamins are very useful, especially group B. With weakness and numbness, anticholinesterase drugs are indicated, they block a special enzyme - acetylcholinesterase, and the impulse has the ability to continue along the nerve. If there is muscle tension, means are shown to relieve it.

Compliance with the regime

In the postoperative period, a special regimen will also be required, which must be strictly followed. You can’t sit for a month, squats are allowed, for example, while going to the toilet. But you need to walk, as soon as possible it is allowed to do this from the second or third day after the operation. During this period, it is important not to be zealous, there should be breaks during which a person takes a horizontal position in bed. The duration of this break is approximately half an hour.

In the period from 2 to 3 months, the use of a semi-rigid corset is indicated, it is necessary to prevent the recurrence of an intervertebral hernia in the lumbar region. In addition, it will help to form the correct posture. During this period, it is forbidden to carry weights that exceed 3 to 5 kg, travel in public transport, or ride a bicycle.

Physiotherapy

There are many methods of physical impact on the operation site, and each has a unique therapeutic effect, is used at one stage or another of the rehabilitation treatment, and lasts for a certain time. The most common:

The technique of electrophoresis or iontophoresis is used to help drugs penetrate into the deep tissues of the body. It allows you to reduce pain and speed up recovery after removal of the intervertebral hernia of the lumbar.

Muds can reduce pain and inflammation, they have a resolving effect on postoperative infiltrate and scars.

Due to ultrasound, recovery is faster, cells receive more nutrition and actively grow.

UHF allows you to improve blood flow and increase the tone of the ligaments and muscles. The procedure reduces pain and relieves the inflammatory process.

Electrical stimulation of tissues can relieve pain syndrome and restore damaged nerve roots. After the procedure, the nutrition of cartilage and bone tissue improves.

Phonophoresis is a technique by which drugs are introduced into the body under the influence of ultrasound. The action is the same as that of massage, but there is no mechanical effect on the tissues. There is an anti-inflammatory and anti-edematous effect on the body and the site of the operation.

In magnetic therapy, a low-frequency magnetic field acts on tissues. As a result, metabolic processes are activated, inflammation, swelling, pain decrease, mobility is restored faster.

The use of massage

After surgical treatment in the first week, a light massage of the limb on the side of the lesion is shown. The procedure is especially necessary for weakness, numbness, reduced reflexes - in general, symptoms characteristic of root damage. You can switch to the lumbosacral region no earlier than 1 or even 1.5 months after the operation. This is due to the healing processes at the site of the surgical intervention. There is no need to rush with a massage at the stage of rehabilitation treatment.

Physiotherapy

But this method of rehabilitation treatment begins as soon as possible after the operation. In the first ten days, dosed walking is allowed for a certain distance, then a break is taken for about half an hour. This is complemented by a set of exercises for contracting the muscles of the body, as well as gymnastics for the lungs. Performed while lying in bed.

After up to a month, active gymnastic exercises are performed in the position on the back or stomach. And after a month you can go to classes in the exercise therapy room and always under the supervision of an instructor. A visit to the swimming pool is recommended 6-8 weeks after the operation.

Acupuncture

The method is used at any stage of rehabilitation treatment. It is optimal to use a month after the operation, when all tissues heal well and a scar forms. It is undesirable to combine the technique with the electrical effect that electrophoresis and diodynamics have.

The recovery process after removal of a lumbar hernia is not so short and may require some time and effort. In each specific case, only an individual rehabilitation program is selected for a person.

2016-04-05

Surgery to remove a hernia of the lumbar spine

After 40 years, many of us are faced with various diseases. Of particular concern are hernial protrusions of the intervertebral space. Although at that moment few people realize that they have this disease, and even more so about the possible consequences. But at the same time, symptoms in the form of acute pain in the spine during movement and after a hard day are constantly disturbing them.

  • Indications for surgical treatment
    • Endoscopic
    • Microsurgical
    • open type operation
    • Laser vaporization
    • Cold plasma nucleoplasty
    • Hydroplastic
    • Intraosseous blockade
  • Possible Complications
  • Conclusion

Faced with these unpleasant sensations, many believe that this is due to intense physical exertion or accumulated fatigue. And when they go to the hospital to see a general practitioner, they are usually diagnosed with sciatica. But if a person discovers such signs in himself, then most likely the reason for all this is connected with the intervertebral disc, the disruption of which is fraught with extremely undesirable consequences.

The level of modern medicine is quite high, therefore, with timely access to doctors, it is possible to cure any pathology of the spine with the help of surgical intervention in a short time.

Indications for surgical treatment

Indications for an operation to remove a hernia of the lumbosacral spine can be presented in the form of two groups:

  • relative;
  • absolute.

The former refers to situations where surgery is the only way to help a person regain health.

Speaking about relative indications, one should keep in mind the circumstances when conservative methods of treatment did not bring the desired results.

  • Serious pathologies in the work of the pelvic organs, which manifest themselves in the form of urinary retention or increased frequency, changes in erection and the appearance of constipation;
  • Loss of motor ability of muscles, paresis of the lower extremities. This condition leads to dysfunction of the mechanism of extension and flexion of the feet;
  • Vertebral hernia, accompanied by sequestration, during which prolapse of the nucleus pulposus is noted. During this form of hernia, the nerve roots are infringed, which creates inconvenience for the patient, who begins to feel severe and sharp pain.

Relative readings include the following:

  • The absence of positive changes as a result of the use of conservative methods of treatment. In cases where after 2 months of treatment it was not possible to achieve the desired results, the doctor may decide to perform an operation.

Before agreeing to an operation to remove a hernia of the lumbosacral spine, you should familiarize yourself with the positive and negative points.

The main advantage of the operation should be called the fact that after the removal of the intervertebral hernia through surgical intervention, an instant result is provided.

The operation immediately relieves the usual symptoms of the disease in the form of stiffness of movements, pain, headaches, dizziness, etc.

As for the disadvantages of surgical intervention, it is necessary to remove a hernia of the lumbosacral spine in inflamed areas where weakened muscles are located, so there is a possibility of new hernias, relapses of the disease, and protrusion of the intervertebral discs.

Among the innovative operations, the most common are:

Endoscopic

Required during the use of local anesthesia. For such operations in the lumbar region, an endoscope is used, which is brought to the herniated intervertebral disc, using a small incision made in advance, no larger than 0.5 cm. The treatment process can be monitored on a special monitor.

With the help of this type of treatment, the surgeon manages to quite successfully remove the hernia and the remnants of the nucleus pulposus of the disc, while the spine, even a small part of it, is not affected in any way.

The advantage of lumbar surgery is that this method of surgical intervention completely eliminates spinal injuries, therefore, upon its completion, the risk of complications is minimized, and the rehabilitation period is also reduced. Usually, after carrying out all the necessary surgical actions, a restorative laser is used to treat the operated site.

The patient has to stay in the hospital for another 1-3 days, and from that moment he is allowed to engage in any non-heavy activity. After 2-6 weeks, he can return to performing any physical labor.

Microsurgical

Circumstances do not always allow removing a hernia in the lumbar region with the help of endoscopic surgery on the spine. In this case, the possibility of microsurgical removal of the intervertebral hernia can be considered. However, it should be noted that during such an operation it is necessary to make an incision. The process of hernia removal was controlled using an operating microscope: it is installed outside the place where the operation is performed, so the data received on the monitor is not as accurate, unlike endoscopic surgery.

The main advantages of this method are:

open type operation

Already by the name it is clear that this method of surgical intervention does not involve the use of special optical devices. Removal of a hernia is carried out directly by a specialist. But the success of the operation largely depends on the professionalism and experience of the doctor.

Minimally invasive ways to deal with herniated discs

Most patients who are diagnosed with a herniated disc, in very rare cases, have to remove the tumors through surgery. This need usually arises with the development of neurological complications.

If there is no such risk, then we can limit ourselves to carrying out therapeutic measures designed to eliminate the pain syndrome. This can be done with the help of modern minimally invasive methods of treatment that do not cause any harm to the body, and after their application, the patient can quickly return to his usual way of life.

With the help of the considered methods of treatment, you can:

  • Eliminate pain symptoms;
  • Reduce protrusion;
  • Regain interest in life.

Laser vaporization

The decision to perform such an operation on the spine is made by specialists if there is a protrusion of the disc and there is no sequestration.

The process of hernia removal is carried out using a needle, which is used to insert a laser light guide and supply a dosed energy flow.

This method of treatment allows you to turn the liquid of the intervertebral discs into steam, thereby reducing the pressure inside the disc itself to a large extent.

An additional plus from using the method is to eliminate the infringement of the nerve roots, as well as to reduce the number of nerve receptors.

The main advantages of this method are:

  • The speed of the operation - it takes no more than 1 hour to complete it;
  • No scarring after surgery;
  • The ability to repeatedly carry out processing in different areas;
  • A short rehabilitation period, as well as a minimal risk of complications.

Cold plasma nucleoplasty

This method of hernia removal is carried out using a needle, through which a special plasma enters the intervertebral region, which affects the hernia cells with low temperatures. The operation is carried out until their complete destruction.

But this method of hernia treatment has a serious disadvantage - even after its successful implementation, there is a possibility of a relapse of the disease.

The main advantages of this treatment method are:

  • Instant relief of pain immediately after the completion of the operation;
  • The minimum time of the operation - it takes no more than half an hour;
  • The operation is performed on an outpatient basis, which does not require the preparation of an operating room;
  • Immediately after the operation, the patient can return to their normal lifestyle.

Hydroplastic

The basis of this method of hernia treatment is carrying out a nucleotomy using a special cannula, which is inserted into the cavity of the intervertebral disc.

The main advantage of this method of surgical intervention is the low level of trauma, the ability to prevent the occurrence of necrosis of the intervertebral disc, and the restoration of its depreciation functions.

The hydroplasty method is most often indicated for local pain in the lumbar region, if the size of the hernia does not exceed 6 mm, and it is also necessary to eliminate pain that radiates to the legs.

The considered method of treatment cannot be used to remove a large hernia, in the presence of oncopathology, significant damage to the fibrous ring, the presence of an infection inside.

Intraosseous blockade

The method of hernia treatment is based on the use of a special hollow needle, which is used to puncture the spine. In the future, with the help of it, a specially selected medicinal solution is introduced, which allows you to eliminate pain symptoms. This method of therapy is necessarily carried out with the use of local anesthesia.

The main advantages of this method are:

  • The ability to quickly relieve pain;
  • The ability to inject the medicine exactly into the required section, eliminating the risk of harm to internal organs.

Disadvantages of the method:

  • The effect of using the method persists in patients for different times. Most often it lasts from 1.5 to 5 years. If in the coming months there is no sign of hernia growth, and no complications are expected, then several cycles of blockade are allowed. As a result of such events, the patient can forget about pain for a long time.
  • After the operation, the patient must adhere to bed rest for some time. Usually, experts recommend that operated patients lie down for five to six hours, otherwise there is a danger of spreading the injected drugs to nearby organs and tissues.

Possible Complications

Most people, when they hear the word "surgery", become very nervous, since this method of treatment involves certain health risks. When agreeing to remove a hernia of the spine with the help of an operation, it must be taken into account that certain complications may subsequently arise.

These complications can be presented in the form of 2 groups:

  • arising during the operation;
  • postoperative complications.

The first occur during the direct removal of the hernia. This may be accidental damage to the nerves, which is fraught with the development of paralysis and paresis. If a problem is immediately detected during the operation, the surgeon will immediately try to take it in. If this is not done, then after the removal of the hernia is completed, this error will cause a lot of inconvenience to the patient, who will be disturbed by severe headaches.

Therefore, in order for the operation to be successful, it is necessary not only to carefully choose the instruments and method of hernia treatment, but also to the doctor who will perform the operation.

Conclusion

An intervertebral hernia is a serious disease that can complicate the life of any person. Many, unfortunately, seek help too late, when they are no longer able to endure the pain that occurs in the spine. Some patients may even require surgery, and it is not a fact that this will not lead to undesirable consequences. In this case, they need to decide on the method of removing the intervertebral hernia.

There are many ways to treat this disease with the help of surgical intervention, and each has its pros and cons. This must be taken into account, but one must not forget that the success of the operation largely depends on the professionalism of the surgeon.

After surgery to remove the hernia, a period of rehabilitation begins. And this time is the most difficult and responsible for both the patient and the doctors. After all, successful recovery depends not only on the experience of the surgeon, but on the desire of the patient to fight the disease to the bitter end.

Problems in the first weeks

Modern surgery has made some progress. Now, after the removal of a hernia of the spine, the patient does not require long-term hospitalization. The patient goes home for 2-5 days, receiving the doctor's recommendations. During this period, many questions arise that may not be immediately covered. So, rule number one is to have a phone number or other available means of contacting your doctor if you are going home after surgery. This is the key to your peace of mind.

The first weeks of open surgery are very difficult. The patient experiences pain that is not associated with pinching of the nerve, but with surgical procedures. Therefore, in addition to medicines, the patient needs moral support. Family people should rely on loved ones, and lonely people should notify their friends about the operation - someone should be nearby during this period.

Any activity is carried out with the permission of a specialist. Basic rules: minimum loads, their gradual increase, no sudden movements. During operations on the bone part of the spine - strict observance of the requirements of the doctor and instructor in therapeutic exercises.

The initial period is fraught with the appearance of some reactions that bring pain and discomfort, but are not dangerous to health. For example, spinal anesthesia can cause headaches 2-3 days after surgery. The pain syndrome is caused by the loss of CSF through a puncture in the hard shell. To prevent this phenomenon, it is enough not to get out of bed for a day after the operation and drink plenty of fluids. By the end of the week, the patient may experience "old" pain in the back and lower extremity. With hernias of the cervical region, pain radiates to the hand. As a rule, this is not a recurrence of the disease, but postoperative edema. For its relief, analgesics (ketanov, oxyten), drugs for removing fluid (detralex, L-lysine aescinate) are used. By the seventh day of rehabilitation, the symptoms go away on their own.

When should you call the doctor?

  1. When the temperature rises. If the numbers on the thermometer are 37.5, this is not a cause for concern. But a fever above 38 indicates the development of a serious complication and requires immediate examination by a specialist.
  2. In violation of the function of organs and limbs. Some complications or incorrect actions of doctors can provoke paralysis. If you have these symptoms, be sure to go to the hospital.
  3. With the appearance of redness and the presence of discharge in the area of ​​the postoperative wound. Sometimes it is enough to turn to an outpatient surgeon to correct the treatment. But it is better when infectious complications are seen by the operating doctor.

Fixation

Rehabilitation after removal of a hernia is carried out with the obligatory fixation of the problematic department. We will talk about the timing and indications for wearing a corset or orthosis below.

The correct corset is a retainer with rigid metal inserts 30-35 cm wide. It takes on the entire load, supports the muscles of the lumbar and sacral region. Recovery of soft and bone tissues will not be complete without such a bandage.

The latch must be put on in a horizontal position. The best option is a corset with additional fixation straps. They allow you to change the tension force of the orthosis. These recommendations are relevant for lumbar disc herniation. What to do during neck surgery? The Philadelphia-type orthosis will help to keep immobility.

You can stand and walk in a corset for a short time. The main rule is to increase the load daily with a long rest. If you start with 15 minutes a day, by the end of the week your vertical activity time should be 35-40 minutes. Between them pauses on a horizontal plane (about an hour).

Wearing a corset does not preclude washing it. Usually in the postoperative period, patients have increased sweating. In this case, stock up on two orthoses.

Exercise after surgery

Exercise therapy during the recovery period is applied from the third day of surgical treatment. Therapeutic gymnastics is performed in the supine position and helps to activate the muscles. Exercises are performed slowly, calmly, breathing should be even (inhale through the nose, exhale through the mouth). Therapeutic gymnastics is performed in 4 poses:

  • exercises lying on your back;
  • abdominal exercises;
  • side exercises;
  • quadruple exercises.

The basic rules of exercise therapy during the recovery period: the absence of pain during movement, the smoothness of execution, the regularity of the exercise. So, from the third day, you can do the following exercises:

complex on the back

  • arms extended along the body. The palms are facing down. Hands push off from the horizontal plane for 2-3 seconds. Then relaxation. Repeat several times (1-2) daily increasing the number of repetitions to 15. This recommendation applies to any exercise;
  • lying on the stomach, we unbend our head, clench our fists and pull the toes of both feet. We return to the original position;
  • bend your knees and spread out to the sides. We tilt the knee so as to touch the opposite heel;
  • hands are spread out to the sides. We take out the opposite shoulder with the palm;
  • we squeeze our palms on our chest in the “prayer” position. We hold the effort for 2-3 seconds;
  • brushes "on the castle". Effort unclench the "lock";
  • make a bicycle with one foot. The second is bent at the knee. We alternate limbs;
  • end with pelvic lifts. Inhale up, exhale down.

Abdominal exercises

Charging in this position is not carried out in the first days of recovery. Exercises are used closer to 3 weeks after surgery:

  • arms spread apart, raise one leg up, return to its original position. Repeat with the other limb;
  • hands are spread out to the sides. Raise the shoulders and chest. We go back;
  • we crawl in a plastunskin place;
  • lying on your stomach, raise your knees, using the work of the muscles of the buttocks. The toes of the feet rest on the floor;
  • raise your legs bent at the knees. After we straighten the joints. We return to the starting position.

Complex on the side

  • the right arm is bent at the elbow and placed behind the head. Left we rest on the floor. We pull our knees in ourselves, straighten our legs again. Next, change sides;
  • raise the leg up, first one, then two at once.

Complex on all fours

  • with the right knee we take out the left elbow, then we change sides;
  • we stretch the right arm and left leg parallel to the body, change limbs;
  • we sit on our heels, the back arches.

Sitting problem

Sitting down in the postoperative period should be very careful. After microdiscectomy and laser vaporization of the intervertebral hernia, you can sit in the first hours after surgery. Other surgeries that involve more trauma have different requirements in this regard.

Sitting is only allowed after 3 weeks. You need to sit down only for a short time when getting out of bed. After the third week, you can sit for 15 minutes a day, increasing the time to an hour by the first month. The chair for sitting should have a back and a deflection forward in the lumbar region. In the absence of such a modification, place a roller or rolled up blanket under your back.

Patients spend most of their working time sitting. When going to work, this causes a complication of the disease, as the load on the operated spine increases. To prevent problems, there are a number of simple rules that must be strictly observed:

  1. You can not sit for more than 60 minutes. The rehabilitation period ends in 2-3 months. And the patient returns to his usual activities. In order not to provoke a complication after the operation, get up from your chair every 45-50 minutes and do a small set of exercises.
  2. You can't drive for a long time. The patient returns behind the wheel only 1.5-2 months after the operation. Take care of the comfort of the chair (roller under the back or orthopedic pads). If you have a long trip, then every hour you need to stop (you can unload your back with the help of charging).
  3. Seating positions must have armrests, which should be supported before landing.

Aquatherapy

Swimming is a unique way to tone your back muscles. In water, the load on the spine is significantly reduced. But swimming after surgery on the intervertebral hernia is a lesson for the second month. The patient's rehabilitation potential is higher by this time, and the scar in the back is fully formed. Therefore, the risk of infection is minimal.

So, what subtleties should be considered when exercising in the pool?

  • the postoperative wound must heal completely;
  • physical therapy precedes classes in the water;
  • an instructor is constantly in the pool with the patient;
  • swimming can be alternated with elements of exercises in the water.

Horizontal bar

The rehabilitation period after surgery on the intervertebral hernia lasts quite a long time. After 3 months of the protective regime, you can return to your usual way of life. However, some restrictions remain for life. These include gymnastics on the horizontal bar. Most experts advise to abandon such physical activity with an intervertebral hernia. And after the operation, exercising on the horizontal bar is categorically contraindicated.

Why can't pull-ups be used for muscle rehabilitation after a herniated disc? Few can withstand charging on the horizontal bar. For proper pulling and hanging, you need strong arm muscles. But any activity on this projectile is associated with significant effort and jerk. It is difficult to perform the exercise gently and smoothly without preparation. Sudden movements are strictly contraindicated for sick people. If the patient does not control his spine, then you can get injured or complication of the disease. Therefore, with hernias, avoid horizontal bars, especially if you are overweight.

Spinal cord injuries are not uncommon these days. All sorts of problems with the spine have both older people and very young people. Modern medicine has long been armed with effective methods for the treatment of fractures and injuries on the spine. One of the methods is an operation to install a metal structure directly on the bones of the spine. This is practiced in case of damage to the spinal column.

  • Why can the spinal column be damaged?
  • In what cases is an operation to install a metal structure needed?
  • Classification of metal structures
    • Rehabilitation Tips
    • Contraindications to the removal of the structure

Today we will tell you how such an installation can shorten the period of rehabilitation after injuries and how wearing it affects a person’s everyday life.

Why can the spinal column be damaged?

There are many reasons why you can hurt your back. As a rule, this happens with excessive exposure to one or another part of the spine. Among the common reasons:

  • falling from a great height;
  • collapse impacts;
  • car accident.

Injuries are most exposed to the most fragile parts of the spine:

  • lumbar;
  • cervical.

This can lead to death or lifelong immobilization. But in order to understand the nature of spinal injuries, you need to know their classification.

By nature, these damages are:

  • mild bruises that do not require surgery, because they do not leave behind severe clinical manifestations;
  • injuries that occur due to dystrophic processes of the intervertebral discs or ligamentous apparatus. Require surgery - the damaged structure is restored or changed;
  • fractures of vertebral bodies, arches or processes;
  • fractures or dislocations;
  • dislocations and subluxations.

In what cases is an operation to install a metal structure needed?

The cervical and lumbar spine are exposed to such pathological processes during injuries:

  • reduction in the diameter of the spinal canal;
  • changes in the ligamentous apparatus and intervertebral disc of a degenerative-dystrophic nature;
  • intervertebral hernia.

In these cases, an operation for prosthetics is prescribed. The patient is given special plates that stabilize the specified section of the spine, immobilize the section or segment.

This method of treatment is widely used for various injuries of the spine. Such an operation minimizes the rehabilitation period, and soon the patient can return to his usual way of life.

Classification of metal structures

Thanks to modern technology, metal structures used for operations of this kind can have different sizes and shapes. They are classified as follows:

  • when installing structures inside the bone canal (intramedullary osteosynthesis), solid or hollow rods, as well as intramedullary rods, both with and without blocking, are used;
  • in extramedullary osteosynthesis (installation of structures on the bone), staples, screws and plates are used.

Compared to previous years, rehabilitation after such operations is quite fast.

Rehabilitation after surgery and its features

With any injury, the body needs to recover and this time is highly dependent on many different factors.

Operations on the spine are among the most complex and traumatic, because it is a protection for another important organ - the spinal cord. The rehabilitation period after spinal injuries can range from 2-3 days (hernia removal surgery) to several years (paresis, organ paralysis or spinal cord injury).

And the wider the area of ​​fixation of the vertebral bodies, the longer the rehabilitation period will be, including bed rest. During these operations, the dynamics of the recovery of the body is controlled by radiography, the pictures are taken every week. In the same period, the specialist is engaged in physiotherapy exercises with the patient, bringing the recovery period closer. In addition to physical education, the patient is prescribed physiotherapy and limb massage. Soon a person will be able to get out of bed and start walking. If your back hurts after surgery, you should tell your doctor. Probably, there is a need to change the way of anesthesia.

To alleviate the patient's condition after the operation, learn to walk with metal structures (the fusion period is on average 3-4 months), he needs to wear a special medical corset. It will need to be worn for about a year, and the process of adaptation to an extraneous design can take up to 2 years.

The already listed spinal rehabilitation measures improve blood circulation and develop ligaments and joints:

  • Do physical therapy exercises every day. They help not only restore the former functions of the back, but also strengthen the muscles, and this, in turn, helps to significantly ease the load on the vertebrae by wearing a muscle corset;
  • massage your back regularly. This procedure will increase blood flow to the area of ​​injury, and the more blood circulates in this area, the faster the spine will recover;
  • A fairly popular and relatively old method of rehabilitation is physiotherapy. This method works through natural factors such as laser, ultrasound, cold, heat and magnets. This treatment helps to improve blood microcirculation, develops the body's regenerative abilities and has a beneficial effect in every possible way;
  • reflexology is a controversial method of spinal rehabilitation after surgery. It involves the impact on some points located on the body and allows you to tone the muscles and increase blood flow.

It is very important to remember to take care of the stitches after the operation. If hygiene is not observed, then the suture material will become the entrance gate for infection. This can provoke inflammatory changes and rejection of the established material will begin. In such cases, lethal outcomes are not excluded. If the suture material is infected, the patient is prescribed a minor operation, in which case the old material should be removed, the wound re-treated and sutured.

Why are metal structures sometimes removed?

The reasons why metal structures are to be removed are absolute and relative.

Absolute reasons include:

There are fewer relative reasons for implant removal:

  • psychological factor or desire of the patient. Not everyone can calmly relate to the presence of a foreign body in the body;
  • physical discomfort when the design interferes with doing certain actions or wearing clothes.

Contraindications to the removal of the structure

If the patient asks the doctor to remove the construction, then he must weigh all the pros and cons of a second operation. Contraindications in this case are:

After a period of rehabilitation, the restoration of lost functions begins, and in severe cases they can be restored at least partially. But remember that if repeated trauma occurs in the affected area, then this can cause more serious complications, which will take a longer time to treat.

The operation on the intervertebral disc does not end the treatment of intervertebral hernias. In order for a person to return to normal life, a recovery period and intensive rehabilitation are necessary. In some cases, complications develop after the operation, although due to the development of medical technology, their number is minimal.

Possible complications after removal of the intervertebral hernia

Complications can be divided into intraoperative and postoperative.

Intraoperative ones develop during the operation and largely depend on the skills of the operating surgeon, the method of surgical intervention, and the instruments used for manipulation. The consequences of the operation on the vertebral hernia are different.

There are two main complications:

  1. Nerve damage. In the immediate vicinity of the intervertebral hernia, as a rule, there is a root of the spinal nerve, the compression of which causes the clinical picture of the hernia. Discectomy may inadvertently damage this root. In the postoperative period, this fact will be manifested by a violation of sensitivity or muscle weakness in the corresponding leg (paresis and paralysis).
  2. Damage to the dura mater. The observed gap is immediately sutured by a neurosurgeon, but if the gap is not noticed, then in the postoperative period, intense headaches may develop due to the constant leakage of CSF from the spinal canal, which is accompanied by a decrease in intracranial pressure. These effects may persist for up to several weeks until the hard shell heals on its own.

Postoperative complications:

  1. Early:
    • purulent-septic complications (local - epiduritis, osteomyelitis and general - pneumonia, sepsis);
    • thromboembolic complications (pulmonary embolism, thrombosis of the veins of the lower extremities).
  2. Later:
    • recurrence of a vertebral hernia is the most common complication. According to various sources, it ranges from 5 to 30% of all operated hernias;
    • cicatricial adhesive process in the lumen of the spinal canal - accompanied by pain as a result of nerve infringement by scar tissue.

Compliance with the doctor's recommendations during the recovery period and high-quality rehabilitation will help reduce the likelihood of developing late complications after disc surgery and achieve a good quality of life.

Immediately after the operation, a person feels significant relief - the pain syndrome decreases, the functions of the pelvic organs and lower extremities are restored. However, it is worth remembering that restorative treatment is indispensable. During the recovery period after hernia removal, measures are taken to consolidate the achieved result, adapt the spine to new conditions, and form new spinal biomechanics.

Conditionally, the recovery period can be divided into three stages:

  1. at the first, a person follows recommendations aimed at preventing and combating pain;
  2. on the second - adaptation of a person to everyday life;
  3. at the third stage, a set of measures is being carried out, the main purpose of which is the complete restoration of the biomechanics of the spine, the prevention of recurrence of the intervertebral hernia, the strengthening of the musculoskeletal system and the return to a full life.

Depending on the severity of the operation and the volume of the surgery, the recovery period lasts from 4 to 12 months, taking about six months on average.

  1. Do not sit for 1-1.5 months after the operation - in order to avoid early recurrence of hernia and compression of the nerve roots;
  2. Avoid sharp and strong movements involving the spine - forward and side bends, turns with twisting of the spine;
  3. Ride in a car or other form of transport only as a passenger on the unfolded seats, in a reclining position;
  4. Avoid lifting heavy objects - maximum weight 3-4 kg in each hand;
  5. Every 1.5-2 hours to give rest to the spine - lie down for 15-25 minutes;
  6. Wear a semi-rigid corset. To train the spine, wearing time should be limited to three hours a day.

To accelerate the processes of reparation (recovery) during this period, physiotherapeutic methods of influence can be recommended: laser therapy, diadynamic therapy, sinusoidal modulated currents, electrophoresis in the spinal region.

Non-steroidal anti-inflammatory drugs are used to relieve pain.

In general, the early rehabilitation period after removal of a hernia can be characterized by a protective regime - during this time, the postoperative scar heals, the inflammatory process subsides. Then you can move on to more intensive rehabilitation.

Intensive rehabilitation in the postoperative period

After surgery for hernia removal by the open method, the patient is discharged from the hospital after 3-4 weeks, and after endoscopic discectomy - after 1-2 weeks. From the second month, you can begin intensive rehabilitation, including the prevention of intervertebral hernia.

At this stage, exercise therapy and restorative gymnastics are included in the rehabilitation program. These procedures are best done under the guidance of a specialist. The best option is the passage of spa treatment. Experienced exercise therapy instructors work in sanatoriums, there are swimming pools - swimming during the recovery period is of great importance.

If there is no opportunity to get to a sanatorium or a rehabilitation center, you can use video lessons - many developers of recovery programs publish video lessons on the Internet.

Here is a small set of exercises - recovery exercises for self-fulfillment:

  • In the supine position, slowly bend your legs, trying to bring your knees to your chest. Relax your glutes and try to hold this position for 45-60 seconds. Straighten your legs slowly.
  • Lie on your back, spread your arms. Bend your legs at the knees and, leaning on them, raise the pelvis. Hold first 10-15 seconds. Gradually increase the time to 60 seconds.
  • Position on the back. Hands behind the head, legs bent at the knees. Turn your legs, trying to reach the floor with your knees - left and right. The upper body should be kept horizontal.
  • Starting position - leaning on hands and knees. At the same time, we stretch the opposite arm and leg horizontally and hold it for 5-10 seconds - we change legs with arms. Increase the exercise time to 45-60 seconds.
  • Lying on the stomach, hands under the chin. Slowly raise the outstretched leg up, without lifting the pelvis off the floor, lower the leg. Repeat the exercise with the other leg.

In addition to restorative gymnastics after surgery for a herniated disc, it is recommended to undergo acupuncture sessions.

late recovery period

After 6-8 months after surgery on the intervertebral disc, under the supervision of a doctor, you can begin to restore the muscle corset. The activity of exercises to strengthen the muscles of the back is significantly increased.

During this period, manual therapy procedures and massage are added to the complex treatment - at least twice a year. These procedures allow you to finally restore blood circulation in the problem area, return the patient to an active lifestyle and prevent the recurrence of a herniated disc after its removal.

When going outside, do not allow hypothermia of the back - it is necessary to put on a warming belt on the lumbar region. It is worth refusing to wear a strengthening corset in order to avoid atrophy of the back muscles.

Recovery in the postoperative period is difficult. Do not be upset or upset if something does not work right away. You need to work on yourself - your health depends on your willpower. And doctors are happy to help.

Spine operations are performed in extreme cases due to the threat of damage to the spinal cord and possible dangerous consequences - paralysis. But it is not always possible to achieve the effect of conservative treatment for osteochondrosis, the presence of a hernia, especially situations arise when an operation is vital. Such cases include injuries, including fractures of the spine, advanced stages of osteochondrosis, the presence of an intervertebral hernia. Not only the operation is important, but also the rehabilitation period, as a person learns to walk, sit, and move his limbs again. Rehabilitation after surgery on the spine with metal structures has some differences from arthroplasty or removal of an intervertebral hernia, since foreign material remains in the body.

In modern medicine, several types of operations are used to restore the spine. With osteochondrosis, intervertebral hernia, it is important to carry out the technique of arthroplasty or removal and replacement of the damaged area, especially when the disease destroys part of the disc or vertebra. Often prescribed for lesions of the cervical and thoracic regions, less often the lower back. The consequences of an injury often lead to refraction and instability of fixation of the spine, then transpedicular fixation is prescribed - with it, the spine is fixed with screws. Most often, it is used for the lumbar spine, since it is most convenient to fix metal structures there.

Indications for surgery

There are a number of indications and contraindications for performing surgery on the spine. There is a list of diseases that allow the use of surgical techniques. Most often, endoprosthesis replacement surgery or transpedicular fixation is necessary for osteochondrosis with unbearable pain and the threat of paralysis. For example, transpedicular fixation is not recommended for cervical osteochondrosis, since foreign structures are not fixed and the risk of squeezing the vessels and nerves leading to the brain increases.

In case of lumbar pathology due to trauma or intervertebral hernia, the endoprosthetics technique is not always relevant, it is easier to prescribe an operation for transpedicular fixation. Fixation is necessary if an injury is received, since in other ways it is not possible to restore the integrity of the structure, in addition, procedures are carried out to remove fragments.

Allocate a group of contraindications:

  • pregnancy;
  • obesity or metabolic disorders (diabetes mellitus);
  • elderly age;
  • the presence of serious diseases of the cardiovascular system;
  • infectious pathologies;
  • severe osteoporosis.

To perform surgery on the spine, the patient undergoes a complete examination. Also, a person must understand that the impact on the spine, especially the lumbar, cervical, threatens with a number of complications - paralysis, paresis. Therefore, emergency intervention is indicated only if an injury has been received that damaged the integrity of the spine or, due to the impact of an intervertebral hernia, paralysis or malfunction of internal organs has occurred.

Rehabilitation

Treatment for osteochondrosis, intervertebral hernia or after an injury is not considered completed immediately after the operation (arthroplasty or transpedicular fixation). A long rehabilitation period is needed, during which a person learns to live again. It is important at this time to follow the recommendations of the rehabilitation doctor:

It is forbidden to sit during the rehabilitation period, especially if the operation was performed in the lumbar region. You can sit if the technique of cervical arthroplasty is performed and only after the permission of the doctor. It is also not recommended to sit when riding in public transport, as the effect of vibration is harmful.

Physical activity is limited, carrying heavy loads. Even during the period when a person is discharged from the hospital and takes care of himself, it is impossible to lift more than 2 kg with one arm.

Make sudden movements, bend, bend.

Ignore wearing corsets and a number of other recommendations that a rehabilitation coach prescribes.

Sports are sometimes contraindicated for life, depending on the extent of arthroplasty, trauma, or if there is a threat of an intervertebral hernia. It is especially important to refrain from riding horses, cycling or motorcycles, as well as wrestling.

In case of damage to the disc or vertebra of the cervical region, the lower back, it is necessary to periodically undergo a course of massage, osteopathy, and perform therapeutic exercises even after the end of the main stage of rehabilitation.

Stages of rehabilitation

Each variant of surgical intervention has a certain time frame when rehabilitation measures are performed. With a minimally invasive intervention, sometimes after 3 months a person feels full. But consider the classic criteria for rehabilitation, when an arthroplasty procedure or fixation is prescribed after an injury, with an intervertebral disc herniation, osteochondrosis, or removal of fragments.

The total recovery period is from 3 months to a year, but even when the specified period expires, you must follow the doctor's recommendations and take a course of prevention.

In total, there are 3 stages of rehabilitation.

The early rehabilitation period takes up to several weeks, and it consists in preventing complications, healing wounds, and relieving swelling. During this period, medications are prescribed to reduce pain, inflammation and exercise is contraindicated.

The second period is late, lasting an average of two months. The patient is assigned a trainer who shows how to move and take care of himself. Showing massage, physiotherapy, exercise therapy.

The third period is individual and depends on the age of the person, the degree of osteochondrosis, the presence of an intervertebral hernia or the extent of the injury. At first, the trainer deals with a person, and in the future, all activities can be performed at home. Up to one year, physical activity is excluded in order to prevent complications.

The goals of rehabilitation are to get rid of pain, restore working capacity and self-service, prevent recurrence in osteochondrosis of the cervical and lumbar spine, and prevent the occurrence of intervertebral hernia.

Rehabilitation methods

Rehabilitation methods include medication. Moreover, funds are prescribed not only to relieve symptoms, but also to strengthen bones. It is necessary to use chondroprotectors, vitamins, calcium. An obligatory stage of recovery is physiotherapy, since surgical intervention leaves behind inflammation and swelling. The following procedures are used: electrophoresis, ultrasound, mud therapy, laser therapy.

In the first place in importance is massage and therapeutic exercises. The patient is allocated a trainer who individually selects exercises, calculates the load. Those exercises that the trainer shows can be further performed at home in the last period of rehabilitation. The kinesiotherapy method, performed on orthopedic simulators under the guidance of a rehabilitator, is of current interest.

After discharge from the hospital, do not forget about methods such as reflexology, spa treatment.

Physiotherapy

Rehabilitation of the cervical spine with osteochondrosis or after an injury, removal of a herniated disc is carried out with caution. Exercises for the cervical region are aimed at restoring mobility and eliminating injury to nerves and blood vessels.

Physical activity when performing exercises for the cervical region should be minimal. At first, the rehabilitologist does the rotation of the head and tilts to the sides with his own hands, but after a while the patient needs to do the exercises on his own. Tilts back and forth, to the sides and rotational movements are assigned. Exercises are combined with massage and physiotherapy procedures.

After an injury or with osteochondrosis, due to a hernia of the lower back, physical activity when sitting is limited. Exercises are performed standing or lying down, starting with leg raises, torso twists. Tilts are performed when the body has recovered from surgery or injury.

When performing gymnastics, physical activity should not cause severe pain; rest is necessary after each exercise. It is important to monitor breathing, the state of the pulse. You need to do it several times a week.

After removal of a part of a vertebra or disc, physical activity is limited for life so that a second operation is not necessary. If after rehabilitation there is an increase in pain or crepitus appears, then you need to consult a doctor who will prescribe an x-ray, this is especially necessary if a prosthesis or fixation of the vertebrae is installed.

1 month after surgery:

Most of the time during this period you spend in the position of "standing" and "lying", and it is preferable to walk rather than stand. Wearing a corset during this period is mandatory. You can not sit, for 2-3 weeks of the first month after the operation, you can sit down for a minimum time, 15-20 minutes, only during meals. It is important not only how much, but also how to sit. In a sitting position, it is necessary to maintain the shape of the spine with forward deflection in the lumbar region. For sitting, it is better to use a chair with a small seat and a pronounced support under the lower back (computer chair), the height of the chair is such that the knees are lower than the hip joints. We sit on a chair and rest our hands on our knees or on the arms of the chair. When sitting, we shift the buttocks as far back as possible, so that the back of the office chair rests against the lower back (the difference between the office chair and the director's chair is the presence of a gap between the back and the seat, often even the metal holder of the back is bent in this place) with insufficient support under the lower back, put a pillow. We keep this position, with the most straightened back and the deflection of the lumbar forward, for the entire period of sitting. When standing up, do not bend the spine, but move to the edge of the chair and stand with your legs up, and not forward, preferably with your hands resting on your knees or in the arms of the chair. We increase the time in the “sitting” position gradually, adding 5-10 minutes every day. The task is to reach 45-60 minutes of "sedentary" load by the end of the month, which will allow you, having gone to work, to establish a physiologically correct mode - we sit for 45-60 minutes and walk for 5-10 minutes.
Exclude forward bends from your movements, especially for the first 2-3 weeks, by the end of the month, light bows are allowed, like a famous artist, not like a serf begging for freedom. Basically, the need to lean forward occurs when putting on shoes. Destroy lace-up shoes in your wardrobe and get a shoe horn with the longest handle. If necessary, take a half step forward and squat with a straight back.
Remember to properly get out of bed, only now you can simplify this process. To get out of bed, you must first make a few simple warm-up movements with your arms and legs for a stretch, then turn on your side, bend your legs at the knee joints so that the shins and feet hang from the bed and, pushing off with the elbow of one hand and the other hand, sit down. And already from a sitting position, get up, trying to keep your back as even as possible, without making sudden movements.
The main physical activity of this period is physiotherapy exercises and walking. We start with 0.5-1 kilometers a day, the duration of walks must be increased slowly. At the beginning of the walk, you may feel tension when walking, but gradually on the first 100-200 meters, this feeling recedes and a feeling of confidence and relaxation comes. Under other conditions, do not rush to increase the time and distance of walks. By the end of the first month after the operation, walking 2-3 kilometers a day is good, especially if you haven’t done such walks even with a healthy spine. Remember that when you again feel discomfort and slight pain in your lower back, this is a sign that you have gone enough and you need to lie down or sit down, which obliges you not to go far from home and plan your way there and back in advance.

The recovery period may be accompanied by a temporary return of pain. If you experience back pain, first of all take a horizontal position and reduce the load for the next few days. It is necessary to take analgesics (Katadalon, Baralgin, etc.), anti-inflammatory drugs (Diclofenac, Nise, Movalis, etc.), muscle relaxants (Sirdalud, Mydocalm, etc.). About what drugs to take in case of recurrence of the pain syndrome, agree in advance with your doctor. If the pain does not decrease within two to three days, if there is numbness in the legs and perineum, weakness in the legs, difficulty urinating, body temperature rises, redness of the skin in the area of ​​the postoperative scar appears, you should immediately consult a doctor.

2-3 months after surgery:

The period of outpatient treatment ends and it's time to go to work. Before going to work, you need to come for a consultation with a vertebrologist, orthopedist. It is advisable to do an MRI and a study of the biomechanics of the spine, which will help the doctor to objectively assess the effectiveness of surgical treatment and develop recommendations for preventing the progression of spinal disease.

Sitting is allowed 1 month after surgery. Remember that it is important not only how much, but also how to sit. We repeat once again: in a sitting position, it is necessary to maintain the shape of the spine with a forward bend in the lumbar region and. For sitting, it is better to use a chair with a small seat and a pronounced support under the lower back (computer chair), the height of the chair is such that the knees are lower than the hip joints. We sit on a chair and rest our hands on our knees or on the arms of the chair. When sitting, we shift the buttocks as far back as possible, so that the back of the office chair rests against the lower back (the difference between the office chair and the director's chair is the presence of a gap between the back and the seat, often even the metal holder of the back is bent in this place) with insufficient support under the lower back, put a pillow. We keep this position, with the most straightened back and the deflection of the lumbar forward, for the entire period of sitting. When standing up, do not bend the spine, but move to the edge of the chair and stand with your legs up, and not forward, preferably with your hands resting on your knees or in the arms of the chair.

You can drive a car in 1.5-2 months. If your journey to work by car is more than 1 hour, then you need to take breaks. Stop, take your time, get out of the car, just walk around and do some warm-up exercises with backbends to the sides, do a few squats with a straight back - “on toes”. Traveling by public transport is fraught with another danger, uncontrolled movements, so a corset for the duration of the journey is a must.

During the first months after returning to work, you should not engage in heavy physical labor (lifting weights, digging the ground, etc.). You can apply this calculation: a month after the operation, you can lift 1 kg for each arm, every month it is allowed to add 1 kg for each arm. But remember, and in the future, try to follow the rules of the safety instructions for movers, which determines that when carrying heavy loads, the maximum permissible load is: for male adolescents from 16 to 18 years old - 16 kg; for men - 50 kg. For women - 10 kg, up to two times per hour, when alternating with other work and 7 kg - when lifting weights constantly during the work shift. Since 2008, the maximum weight allowed to be lifted by airline loaders in the United States has been limited to 35 kg, while a semi-rigid corset is part of the loader's mandatory overalls.

All this knowledge of correct behavior, movements, work had to be applied from childhood in order to prevent the formation of a hernia, but if everything happened, now apply this knowledge to prevent new exacerbations

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