The "rational" choice of herpes zoster - the role of physical therapy in the treatment of herpes zoster

Author: Zhao Xiaoyi, attending physician at Peking Union Medical College Hospital

Reviewer: Chen Lixia, Chief Physician, Peking Union Medical College Hospital

"Can I do physical therapy if I have shingles?" "Is physical therapy the same as 'electrical therapy'? What effect does it have? How long does it need to be done? What is the appropriate frequency?" "Is physical therapy useful for postherpetic neuralgia?" "Do physical therapy and medication affect each other? Can they be done together with acupuncture?" In the rehabilitation medicine clinic, we often encounter similar questions, and today we are here to answer your questions one by one.

1. What is "physical therapy"?

Since the embryonic period, humans have been constantly affected by various physical factors, such as temperature, light, the earth's magnetic field, etc. In daily life, everything from heating food, drying bedding to sterilize and sunbathe to supplement vitamin D, to radiotherapy for tumors, all use the characteristics of physical factors.

So, what is physical therapy? Physical therapy is the abbreviation of physical factor therapy.

Physical factor therapy has a long history. In the "Shennong Bencao Jing" of the Eastern Han Dynasty in my country, there is a record that "magnets can treat rheumatism and joint swelling and pain." Wu Shangxian, a Qing Dynasty physician known as the "master of external treatment" in traditional Chinese medicine, wrote "Lihua Pianwen", which elaborated on methods such as sun exposure, fire roasting, fumigation, hot ironing, and thin plastering. The ancient Greeks found that fishermen who were injured by electric fishing had their joint pain relieved. Hippocrates, the father of Western medicine, used mineral springs, sunlight, and seawater to treat diseases.

We ordinary people like to call physical therapy "electrical therapy", which is just like calling all vegetables "vegetables", which makes sense but is not completely accurate. Because electricity is only one of the physical factors, the physical factors involved in physical therapy include sound, light, magnetism, cold, heat, pressure, water, etc.

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2. How do physical factors cure diseases?

The main therapeutic effects of physical factors include anti-inflammation, analgesia, inhibition of pathogenic microorganisms, accelerated injury healing, etc. The effects include three links: ① the body's absorption of the energy of physical factors; ② the absorbed energy causes physical and chemical reactions such as biophysics, biochemistry, biomagnetism and electrodynamics; ③ ultimately causing changes in local cell function, microcirculation and material metabolism, and causing systemic adaptive reactions through neural and endocrine signal pathways. Ultimately, the purpose of relieving symptoms and treating diseases is achieved.

Therefore, we can regard physical factors as "drugs". Sound, light, electricity, magnetism, cold, heat, pressure, etc. are equivalent to different chemical components of drugs. Similarly, it can be compared with drugs that physical factor treatment also has a certain dosage and frequency, and also requires a certain course of treatment. It can also be used in combination with two or more, and also has indications and contraindications. Of course, it can also be combined with other treatment methods such as drugs.

3. If you have shingles, is physical therapy helpful?

It works! It definitely works!

For patients with herpes zoster, physical factors can be used as an aid in treatment in addition to drug treatment. The principle of early treatment applies to everyone, and you can go to the rehabilitation department for medical treatment at the beginning of the disease. In the first stage, the acute stage of herpes zoster, high-frequency electrotherapy, ultraviolet therapy and semiconductor laser therapy can be used to control inflammation, promote the healing of skin lesions and relieve pain, and prevent postherpetic neuralgia. In the second stage, patients whose blisters and rashes have healed but still have local pain, itching and other discomfort symptoms can use high-frequency electrotherapy, semiconductor laser therapy and magnetic therapy to relieve nerve irritation symptoms.

Extracorporeal shock wave therapy, a new favorite in the field of physical factor treatment of pain in recent years, can also be used to treat postherpetic neuralgia. One course of treatment is repeated 4 to 6 times at intervals of 3 to 5 days.

Most physical therapies are difficult to achieve the desired effect in one treatment. Generally, treatment requires continuous treatment every day or every other day, and a total of 5 to 20 treatments depending on the severity. As a part of treatment, physical therapy can be used in conjunction with drugs, minimally invasive interventional surgery, traditional Chinese medicine, acupuncture, etc. to achieve twice the result with half the effort, adding more power, and icing on the cake.

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4.What should I pay attention to during physical therapy?

Patients who have never been exposed to physical therapy sometimes worry whether the "electric heating" will be very uncomfortable or whether they will get "electric shock". In fact, after decades of equipment updates, the comfort and safety of physical therapy can be guaranteed by choosing appropriate treatment methods according to indications. It is common to encounter patients who are troubled by illness and feel relaxed during the treatment and feel so comfortable that they want to doze off.

However, physical therapy is a "medicine" and cannot be used casually. Generally speaking, high-frequency electrotherapy is contraindicated for those with high fever, malignant tumors, bleeding tendency, tuberculosis, pregnancy, local metal foreign bodies, and cardiac pacemaker implants; phototherapy is contraindicated for those with photosensitive diseases, and attention should be paid to eye protection when acting on the head and face; other physical therapies should be used with caution on the abdomen of pregnant and menstruating women. Please follow the doctor's advice for specific precautions.

5. Facial paralysis occurs after facial herpes zoster. Is there any way to help recovery?

When the herpes zoster virus invades the geniculate ganglion and facial nerve of the head, it can manifest as a triad of facial paralysis, ear pain and external auditory canal herpes, known as Ramsay-Hunt syndrome. This is a special type of herpes zoster infection, so conventional treatment for herpes zoster is effective. In addition, it is necessary to perform relevant functional exercises for the weak facial muscles as soon as possible. You can use your fingers to assist the affected side of the face, and refer to the movement patterns of the opposite side to perform movements such as raising eyebrows, frowning, closing eyes, lifting noses, baring teeth, puffing cheeks, pouting lips, smiling, and laughing. Each movement is 10 to 20 times as a set, and repeated 2 to 3 sets, step by step.

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6. After herpes zoster on the limbs, there will be decreased muscle strength, muscle atrophy, or limb swelling. What can be done to help recovery?

Patients who develop focal neurological symptoms during treatment of herpes zoster should first be further diagnosed. If muscle weakness and atrophy occur in the rash-related area, it is considered to be caused by herpes zoster. Limb function rehabilitation exercises can be performed as soon as possible after the onset of the disease. Generally, progressive resistance training is used to promote muscle strength recovery and prevent muscle atrophy. Some patients will experience limb swelling, and physical factor therapy for swelling can also be selected.