In domestic medicine, the term “Hernia of the intervertebral (intervertebral) disc” is a rather young concept back in the 80s of the 20th century, it did not exist in principle. It replaced the vague diagnoses of “osteochondrosis” (changes in the spinal disc), “sciatica” (pain in the spinal root), “lumbalgia” (pain in the lower back), “dorsalgia” (pain in the back). But they are still placed by doctors who are not interested in the patient and do not want to treat him. The concept of “herniated disc” is a completely different matter.
A hernia of the intervertebral disc is the main complication of osteochondrosis of the spine – rupture of the fibrous ring of the intervertebral disc with the full or partial exit of the pulpous nucleus to the outside.
In the West, the word “hernia” is not even pronounced so as not to harm the patient’s psyche, because there the attitude to this problem is completely different. We are afraid of this word, like babies, “Baba Yaga.” Having experienced discomfort in the neck, many patients do an MRI on their own, without waiting for a doctor’s direction. Quite often in the description of tomography you can see “a hernia of the intervertebral disc [x] size [y]”. And then the intimidation begins. They scare with paralysis, “drying out” of the hand, sudden death and many others. Frankly, I did not have to deal with such cases. After many years of working with patients in whom intervertebral hernias were found in the cervical spine, I can say with confidence that whoever wanted to was cured.
The problem is not ignorance of diagnostic methods and treatment methods. The problem is that the “classical” approaches for the diagnosis and treatment of herniated discs have clearly formed in the medical profession, and the subtleties of the anatomy of the cervical spine have faded into the background. However, in the treatment of hernias in the cervical spine, the use of those methods that have proved their effectiveness in hernias in the lumbar region is contraindicated. The reason for this is the anatomical differences between the two departments.
- Features of the occurrence of intervertebral hernias in the cervical spine
- Causes of hernia in the cervical spine
- Symptoms of the intervertebral hernia of the cervical spine
- Vertebral hernia, treatment in the cervical spine
- Cervical hernia – symptoms, treatment of intervertebral discs
- Intervertebral hernia – causes
- Hernia of the cervical spine – symptoms
- Hernia localization
- What is the danger of a hernia of the cervical spine?
- Intervertebral hernia – diagnosis
- Treatment of a hernia of the cervical spine without surgery
- Massage for a hernia of the cervical spine
- Hernia of the cervical spine – treatment with folk remedies
- Surgery to remove a hernia of the cervical spine
- Hernia of the intervertebral disc of the cervical spine treatment
- Hernia of the cervical spine: treatment
- Symptoms of a hernia of the cervical spine
- The general signs of the disease are as follows:
- Complications of a hernia of the cervical spine
- Diagnosis of a hernia of the cervical spine
- Treatment of a hernia of the cervical spine
- Treatment always begins with conservative methods:
Features of the occurrence of intervertebral hernias in the cervical spine
Your life will depend on how you are met when you are born. Yes, yes, do not laugh. It is the cervical spine that is most injured during childbirth. I worked as a neonatologist for a long time and observed how the neonates “folded their necks”, calling this condition “asphyxia”, “tired of childbirth”, “chronic fetal hypoxia”, etc. In such cases, I fixed the cervical spine to the child, while breathing and heartbeat stabilized.
What next? We grow and develop – each in its own way, and not necessarily in the right way. From time to time, when the body demands to reduce the load, a variety of symptoms will appear: headaches, dizziness, general weakness, sleep disturbance, difficulty in perceiving information . In such cases, you can rest, sleep, take medicine that your neighbor will advise, and return to the ranks of workers . These are not signs of an intervertebral hernia in the cervical spine. These are her harbingers.
Then such stops will become more frequent and longer, and the symptoms will begin to take a permanent character. These are already signs of an intervertebral hernia. The exact time of hernia formation is difficult to determine. Symptoms will increase gradually and imperceptibly.
Causes of hernia in the cervical spine
- Injuries to the cervical region during childbirth
- The head presses on the neck in an upright position with all its weight
- The cervical spine has greater mobility than other parts of the spine
- In the cervical region, the smallest vertebrae and the narrowest canal in which the spinal cord passes
- Only here in the lateral processes of the vertebrae pass vertebral arteries that carry oxygen to the brain
Symptoms of the intervertebral hernia of the cervical spine
- periodic aching pains on the back of the neck, aggravated by sneezing, coughing, turning the head,
- dizziness, sometimes with loss of consciousness,
- gait instability and lack of coordination,
- impaired memory and attention,
- unstable blood pressure
- constant or periodic noise in the head, amplified by turning the head,
- sore throat
- shoulder and shoulder pain
- pain and numbness in the hands and fingers,
- weakness in the hands
- fast fatiguability.
Vertebral hernia, treatment in the cervical spine
Many neurosurgeons, evaluating MRI images, and not the neurological status of the patient, make the wrong decision in terms of the choice of treatment (Following the call of the surgeon from the well-known film “Cutting without waiting for peritonitis . “). Few patients after surgery on the cervical spine note an improvement in their condition, but treating conservatively after surgery is not an easy task. However, we take on such patients and get a positive result.
Over the years, we have been treating patients with intervertebral hernias in the cervical region of very large sizes and the result exceeds expectations.
For example: Patient T., 65 years old
Initially, an herniation of the C5-C6 disk was detected on MRI – 5 mm, spreading upwards by 7 mm. After the first treatment course (30 daily procedures), the patient completely disappeared all the symptoms. Neurological examination also showed the norm. After 3 months, the patient was examined again. Revitalization recommended. After 15 sessions of revitalization, the patient was discharged. At discharge, recommendations were given. The control magnetic resonance imaging performed six months later showed a protrusion of the C5-C6 disk – 2 mm.
I want to note that in our clinic the Glisson loop is not used. Glisson’s loop is used only for traumatic injuries of the cervical spine, and more recently, it has been used to treat intervertebral hernias. We also do not electrophoresis with karipazimom on the cervical spine, so as not to get a back reaction from the vertebral arteries.
The choice, of course, is yours. If you want to be cured, then we are at your service!
Cervical hernia – symptoms, treatment of intervertebral discs
When pain occurs in the neck, a person begins to be interested in what is a hernia of the cervical spine, symptoms and treatment of the disease. Due to a sedentary lifestyle, prolonged work with a computer, the cervical spine is at risk. Tense muscles of the neck, uncomfortable posture, lack of movement or excessive stress lead to degenerative changes in muscle and cartilage, which causes the formation of protrusions and hernia.
Intervertebral hernia – causes
A hernia of the cervical spine is a deformation of the vertebral tissues resulting from improper muscle function. In this case, the vertebra itself and the intervertebral disk become inflamed and mutated. Hernia is the leakage of a jelly-like substance entering the intervertebral disc from the pulpous nucleus. The leaked mass squeezes the nerve endings, disrupting the work of the spine and internal organs.
The intervertebral hernia of the cervical spine appears as a result of the following reasons:
- age-related circulatory disorders that worsen the state of fibrous discs, leading to their drying and brittleness;
- injuries of the cervical spine due to sudden movements;
- osteochondrosis, appearing due to metabolic disorders.
Hernia of the cervical spine – symptoms
Each person should have an idea of what is a hernia of the cervical spine, symptoms and treatment. Identifying the problem at the initial stage helps to avoid serious consequences. If a person begins to develop an intervertebral hernia, the symptoms will be as follows:
- uncomfortable and painful sensations in the neck;
- it is difficult to lower the chin to the chest;
- crunch in the neck with sharp turns of the head.
In addition to general symptoms, there are symptoms of the disease characteristic of each affected vertebra:
1. Hernia between the 1st and 2nd vertebra:
2. Damage to the disc between the 2nd and 3rd vertebra:
- nervousness, depression;
- “Goosebumps” in front of the eyes and on the scalp;
- sweating of the head;
- change in taste perception.
3. The problem between the 3rd and 4th vertebra:
- weakening of smell, sight and hearing;
- trigeminal neuralgia.
4. Violations in the region of the 4th and 5th vertebra:
- ear diseases and nose diseases;
- unilateral paralysis of the muscles of the face;
- difficulty raising arms and tilting the head.
5. Hernia between the 5st and 6nd vertebra:
- sore throat, hoarseness;
- hand tremor, weakness, pain, tingling sensation;
- eye diseases.
6. Disorders of the disk between the 6th and 7th vertebra:
7. Deformation of the disc between the 7th vertebra and the 1st chest:
problems with the thyro >
Shishkevich Vladimir, orthopedic and traumatologist, project editor-in-chief ExpertNews.
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Studying what a hernia of the cervical spine, symptoms and treatment, you should understand where it is located. Between the vertebrae of the spinal column there is a cartilaginous layer – a disk that provides mobility and elasticity of the spine. When parts of the disc are deformed, a jelly-like substance from the middle of the disc comes out, forming a hernia. The hernia is localized between the vertebrae, disrupting the work of the spine and nerves. Intervertebral hernias are called depending on the site of their location. Hernia of the cervical spine is called the letter C: for example: a hernia of the cervical spine c5 – c6.
What is the danger of a hernia of the cervical spine?
Intervertebral hernia of the cervical spine is considered a dangerous disease, leading to serious consequences. Going beyond the spine, a hernia squeezes the nerve endings of the brain and internal organs. Considering what is a hernia of the cervical spine, what are the symptoms and treatment, it is important to learn about the dangers of the disease. Common consequences of cervical hernias include:
- impaired blood supply to the brain;
- impaired vision, hearing;
- paralysis of the muscles of the face;
- problems with smell;
- insufficient functioning of the upper limbs;
- migraines, dizziness;
Intervertebral hernia – diagnosis
Signs of a hernia of the cervical spine are similar to symptoms of other diseases. To clarify the diagnosis, an anamnesis is made, in which the patient’s complaints are taken into account. Then, an examination is carried out to determine the reflexes and search for the damaged area. A hernia in the cervical spine is clearly visible with such studies:
- X-ray: this type of study must be combined with other types of diagnostics;
- MRI: with this instrumental examination, you can see the spinal cord;
- CT (computed tomography): helps to examine the state of bone tissue;
- electromyogram: shows the state of the muscular system;
- myelogram: performed using a contrast medium; determines the narrowness of the spinal canal.
Treatment of a hernia of the cervical spine without surgery
If a hernia of the cervical spine is detected, treatment will include a combination of such procedures and measures:
- Pharmaceutical treatment. This includes drugs that relieve pain and reduce inflammation (Ibuprofen, Meloxicam, Diclofenac) and muscle relaxants (Midocal, Baclofen).
- Physiotherapy. A set of physical exercises that helps to strengthen muscles and restore the working capacity of the spine. A good result in the treatment of vertebral hernias is achieved by systematic swimming.
- Traction, or stretching the spine. It is carried out in the conditions of a sanatorium or a hospital. It allows you to increase the space between parts of the spine, reduce pain, stop deformation processes.
- Physiotherapeutic procedures: electrophoresis, phonophoresis, electromyostimulation. Intended to ease pain and reduce inflammation.
- Massage the spine. It relaxes spasmodic muscles and improves spinal function.
Exercises for a hernia of the cervical spine are done every day for 15-20 minutes, smoothly, without jerking and sudden movements. Gymnastics with a hernia of the cervical spine includes the following exercises:
- turns and tilts of the head;
- circular rotation of the shoulders;
- circular rotations with elbows bent and straight arms;
- hand swings;
- hand lifts with a load.
Massage for a hernia of the cervical spine
Only a neurologist and surgeon can tell you exactly how to treat a hernia of the cervical spine. To do this, they take into account the force of damage to the disc and the amount of hernial protrusion. Massage can be performed only at the beginning of the disease. Massage movements should be light, relaxing, so as not to transmit a hernial protrusion and not to increase pressure on the nerves. Massage should be done by a professional chiropractor. Self-massage with this disease is prohibited.
Hernia of the cervical spine – treatment with folk remedies
A hernia in the cervical spine will decrease and become less painful if we turn to recipes of traditional medicine.
Horse fat compress
Preparation and use
- Melt horse fat in a water bath.
- Apply a thin layer of fat to the fabric.
- Attach a cloth to the neck, cover with cling film and a scarf.
- Stand for two hours.
- Repeat for three consecutive days.
Rubbing with fir oil
- fir oil – 3 drops;
- massage cream – 1 tsp.
Preparation and use
- Mix the ingredients.
- With light massage movements apply mass on the neck to the area of pain.
Surgery to remove a hernia of the cervical spine
Removal of a hernia of the cervical spine is used only in 4% of cases of cervical hernias and is considered an extreme measure. The operation is prescribed for protrusion of the pulp contents of more than 6 mm, severe pain, impaired mobility of the neck and motor functions, vascular disorders. The most effective is the standard operation of removing a damaged disk and replacing it with an implant. After such surgical intervention, the risk of repeated protrusion of the hernia is minimized.
In addition to the usual operation, puncture practices using a laser are used. These operations are considered less traumatic, but they have less efficiency and a higher risk of recurrence of hernial protrusions. With secondary hernia, another operation may be required performed by the endoscopic or microsurgical method.
Hernia of the intervertebral disc of the cervical spine treatment
Hernia of the cervical spine: symptoms and treatment
Between the vertebrae there is an intervertebral disc that acts as a shock absorber. In the center of the disc is a pulpous nucleus surrounded by a strong outer fibrous ring.
A protrusion or loss of the nucleus beyond the fibrous ring is called a herniated disc, occurs in all middle-aged and older people, as a result of natural aging of the spine. Disc herniation can cause compression of the nerve root with the development of radiculopathy in only 2-5% of patients.
Cervical hernia: symptoms
The acute period of disc herniation lasts up to 3 months.
At the moment of a herniated disc, sharp, shooting, burning pains appear in the cervical spine with radiation to the arm, reflexes fall out, sensitivity is impaired, muscle strength in the root innervation zone decreases. The pain intensifies when moving the head, accompanied by numbness, burning, cooling, a feeling of crawling ants and other unpleasant sensations. Each root has its own zone of pain and numbness on the extremities.
The defeat of the roots C1, C2, C3 is extremely rare. In the cervical spine, the greatest load falls on the lower spine, therefore, C6 and C7 roots are most often involved in the pathological process.
With the defeat of the roots C1 and C2, pain, numbness and paresthesia occur in the parieto-occipital region, with the defeat of the root C3, the same complaints are localized in the behind-the-ear area.
The defeat of the root of C4 is characterized by pain and numbness in the shoulder girdle and collarbone, a lump in the throat, and pain in the heart.
When C5 root is affected, pain and numbness spread from the neck to the outer surface of the shoulder. The strength in the deltoid muscle decreases, the patient can not take his arm away.
The defeat of the root of C6 is accompanied by pain from the neck to the thumb. Numbness and paresthesia are more pronounced in the lower parts of the arm. Reduced biceps reflex.
When C7 root is compressed, pain and numbness from the neck and shoulder blade extend to 2 and 3 fingers. The reflex decreases with the 3rd head of the muscle. The brush compression force is reduced.
The defeat of the root of C8 is accompanied by pain and numbness in the neck, shoulder blade, which then spread to the little finger. Weakness in the fingers develops.
Using interstitial electrostimulation, it is possible to reliably confirm or exclude the presence of a disco-radicular conflict with a herniated disc. If after 3 trial sessions there is a positive dynamics, then a herniated disc does not compress the spine.
Within 3 months, the size of the hernia with inadequate load may increase, pain and neurological deficit worsen. If the pain disappeared during therapy, the disc herniation remained in place with all its stages and dangers. Therefore, caution must be exercised during physical exertion.
In the acute period, therapeutic exercises should be done under the supervision of an experienced instructor, avoiding sharp bends and turns in the cervical spine.
After 6 months, the hernia due to natural processes in most patients is reduced by 2 times. Sequestered hernias in half of the patients completely disappear.
After 1-2 years, the size of the hernia will remain unchanged. But recovery is conditional and involves the cessation of pain and a complete restoration of disability.
Hernia of the cervical spine: examination
Currently, the best method for diagnosing disc herniation is magnetic resonance imaging (MRI) of the spine. To obtain high-quality images, apparatuses with a capacity of 1 T or higher are needed with slicing in 3 planes.
Moreover, in almost all middle-aged and older people, examination reveals asymptomatic hernias of the intervertebral discs. The level of disc herniation detected on MRI should coincide with the clinic of the lesion of this root. If the MRI hernia is C3-4, and the fingers go numb, then the hernia is not to blame, you need to look for tunnel neuropathy.
A huge disc herniation can be an accidental find on an MRI without any manifestations.
A small “unsuccessful” herniated disc herniation can cause severe neurological complications and intolerant pain.
The direction of prolapse of the hernia of the disc affects the pain syndrome. Only lateral hernias, which mechanically damage the nerve roots, can cause autoimmune inflammation and radicular syndrome (radiculopathy).
It must be remembered that a disc herniation detected is not an indication for surgical treatment. A significant part of the doctors do not look at the pictures, but only read the conclusion. Many doctors pay attention only to the size of the hernia, but do not take into account the clinical manifestations.
Therefore, it is very important to find your doctor who will correctly analyze your clinical situation.
Cervical hernia: treatment without surgery
So, a herniated disc is not a sentence for surgical treatment.
When do you need to contact neurosurgeons?
There are no absolute indications for emergency surgery for a hernia of the cervical spine. Currently, hernias of the cervical spine are practically not operated on.
We prescribe competent conservative therapy and observe the dynamics of the pain syndrome. The prognosis of a hernia of the cervical spine is most often favorable. The vast majority of patients recover within 3 months. The size of a herniated disc decreases spontaneously regardless of the treatment method used.
If the pain is intolerable or if you need to restore working capacity as soon as possible, then you need to contact a neurosurgeon for epidural blockade with corticosteroids.
Remember that there is not a single drug that resolves hernia.
Manual therapy does not “correct” disc herniation and does not contribute to their reduction.
Corticosteroids are not recommended intravenously or intramuscularly (dexamethasone, prednisone, ambene, etc.). Traction of the cervical spine is contraindicated.
In the acute period, the primary task is to relieve pain as early as possible. For any physical activity, fix the cervical spine with a Shants. Move within the absence of pain, avoid positions and movements that increase pain.
To reduce the pain from the first hours of the disease, non-steroidal anti-inflammatory drugs (xefocam, voltaren or dexalgin, etc.) are used. In the first three days, it is preferable to use drugs intravenously or intramuscularly, then switch to oral administration. Never exceed daily dosages, do not take several drugs at once, carefully read the instructions. Topically, you can also use gels and ointments with NSAIDs.
With intense pain with the ineffectiveness of anti-inflammatory drugs, tramadol is used.
To eliminate muscle spasm, muscle relaxants (midocalm, sirdalud or baclofen) are additionally prescribed.
In case of radiculopathy with the presence of neuropathic pain, anti-inflammatory drugs are ineffective, in this case antidepressants, anticonvulsants, tramadol, versatis patch are indicated.
With mixed pain, anti-inflammatory drugs are combined with amitriptyline or gabagamma.
In chronic pain, physiotherapy exercises, psychotherapy and antidepressants come first in treatment, which not only reduce concomitant depression, but also have an analgesic effect.
Acupuncture, interstitial electrostimulation, hirudotherapy, and therapeutic gymnastics are effective at any stage of treatment for a hernia of the cervical spine.
It must be remembered that a disc herniation is the third period of osteochondrosis of the spine. One year after a hernia, the height of the intervertebral disc is significantly reduced. This leads to an overload of the intervertebral joints with the development of arthrosis in them. Therefore, neck pain will appear more often than in healthy people.
If the patient continues to lead the same lifestyle that led him to the formation of a herniated disc, then after treatment the disease will progress rapidly.
The patient must remember his illness, learn how to sit, move. The main thing is to really assess your physical abilities, which only decrease with age.
Prevention of exacerbations of osteochondrosis of the cervical spine is reduced to avoiding prolonged, uncomfortable postures, prolonged sitting at a desktop or computer. It is important to properly equip your workplace, alternate periods of work and rest. Wear the Shants tire for long trips. Choose the right orthopedic pillow. Do therapeutic exercises to strengthen the muscles of the neck.
Hernia of the cervical spine: treatment
Hernia of the cervical spine: treatment and symptoms.
A hernia of the cervical spine is one of the modern diseases of a rapidly developing society.
Among the hernial formations of the entire spine, this department is second in frequency. Men are statistically affected after 25 years.
The cervical spine is seven vertebrae and the same number of discs located between them.
With destructive changes surrounding the vertebrae and their joints, the ligamentous apparatus (fibrous capsule), a prolapse occurs of a part of the disk with compression phenomena of the nerve fibers of the spinal cord.
This explains the specific sensations in the upper body with this type of pathology.
Morphologically, the disc with contents is protruded and squeezed.
Its subsequent ischemia and impaired conduction of nerve fibers.
In the future, dysfunction of innervation, outflow of blood and lymph from the head develops.
Oxygen starvation and subsequent disruption of the centers of the brain.
Symptoms of a hernia of the cervical spine
Symptoms are very characteristic, but often other diseases are simulated – tumors of various origins and diseases of the peripheral nervous system.
All sensations, their intensity and localization, depend directly on which particular roots of the nerves are pinched – radicular syndrome.
The general signs of the disease are as follows:
- Aching pain and limitation of mobility in the neck and shoulder girdle, aggravated by turning and tilting the head (symptom of Neri and Laseg), raising the arm, sneezing and coughing.
- Dizziness, tinnitus, headaches and uncontrolled pressure surges. Impaired memory and speed of mental reactions.
- Outwardly noticeable deformation of the back of the neck – cervical lordosis and limitation of the range of motion of this part of the spine
- Sleep disturbance, as a result of irritability and reduced concentration of attention and poor coordination of movements.
- Paresthetic phenomena – numbness of the hands from the tips of the fingers to the shoulders, a sensation of tingling, heaviness and “goose bumps”.
The causative factors are: ostechondrosis, spondylosis, the consequences of domestic injuries and occupational hazards, leading to a prolonged stay in an uncomfortable non-physiological position.
An indirect effect is exerted by overweight. In young people who incorrectly or too intensely distribute sports loads, a hernia develops as a result of chronic or acute sports injury.
Complications of a hernia of the cervical spine
Complications of this long-developing and apparently non-dangerous disease can be pathological conditions critical for life:
- Ischemic stroke due to a lack of blood in the brain.
- Infringement or microtrauma of the membranes of the spinal cord – myelopathic syndrome – complete or spastic paralysis of the lower extremities and hands to the elbow joint, paralysis of the respiratory system, flaccid paralysis of the hands.
Therefore, having noticed most of the symptoms, it is necessary to consult a doctor in a timely manner in order to diagnose or exclude the presence of the discussed problem in the spine.
Palpation and visual inspection after interrogation of the main complaints and observation of the usual postures of the body.
Diagnosis of a hernia of the cervical spine
Currently, the main, best and progressive method for determining the presence of a hernia, its location, magnitude and degree of pressure on the nerve processes is MRI – magnetic resonance imaging.
Determine the degree of circulatory disorders of the organs of the head will help Doppler study of cerebral vessels.
For differential diagnosis, the exclusion of concomitant diseases can be carried out additionally – X-ray diagnostics, electrocardiogram (ECG), electromyography (EMG).
Less commonly, due to trauma and high radiation exposure, contrast computed tomography (CT) is used.
In situations of difficult diagnosis with atypical symptoms, laboratory tests are prescribed.
When making a final diagnosis, those vertebrae that were involved in the pathological process of hernia formation are always indicated.
They are labeled with the capital letter “C”, from the word cervicum – in translation from Latin – neck. Be sure to register the number of the vertebra.
For example, the most frequent localization of hernias is found in areas C5-C6 and C6-C7.
Treatment of a hernia of the cervical spine
Treatment always begins with conservative methods:
- General drug treatment includes taking:
- herbal remedies – anti-inflammatory, decongestant and for the regeneration of nerve fibers and connective tissue.
- non-steroidal anti-inflammatory drugs for analgesic effect due to the effect on the focus of inflammation.
- muscle relaxants for muscle relaxation.
- Topically applied various ointments based on diclofenac and ibuprofen, arnica and gastrointestinal.
- Cervical corset and maximum restriction of movements in this department.
- Various physiotherapeutic procedures.
- Therapeutic massage, with the complete exclusion of procedures that cause temperature contrasts – sauna, bath, warming and compresses.
- Reflexotherapy and acupuncture – point or special needles are stimulation of biologically active points on the body.
- Kinesiotherapy and the classical complex of exercise therapy are specific exercises for the relaxation of muscles and ligaments conducted by the instructor or directly by the patient.
- Hirudotherapy is a leech with their enzymes, with a bite: improves blood rheology, local blood circulation, reduces local edema and inflammation, as a result pain and sensory disturbances disappear.
- In the acute period, bed rest is prescribed for a week, rehabilitation after treatment will take 2-3 months.
With the ineffectiveness of prolonged palliative treatment, acute pain, or signs of future complications, surgical intervention is recommended.
Often, it is performed according to vital indications and consists in eliminating the compression factor and indirectly improving blood circulation and innervation.