Chronic lumbar muscle strain (Chronic lumbar muscle strain) refers to the accumulation of chronic injuries to the muscles and fascia of the lumbar region. It is common in people with long-term poor posture or incomplete treatment of acute injuries, especially in the sacrospinous muscle. Chronic lumbar muscle strain is a common cause of lumbar pain, and it can occur in people from all walks of life. Etiology Long-term work in lumbar force-holding or bending activities, as well as long-term poor posture of the lumbar region are the main causes of lumbar back muscle and fascia strain, and there are also acute sprains and contusions of the lumbar region that fail to receive timely and effective treatment, or incomplete treatment, or repeated minor injuries, resulting in local qi and blood stagnation and meridian obstruction. If the body is weak and the kidney is deficient, the lumbar region is not solid and is susceptible to external evil and strain, which makes the disease easy to develop, or to be prolonged. Clinical manifestations and diagnosis The pain is mostly vague, sometimes light and sometimes heavy, often recurrent, relieved by rest, aggravated by exertion, relieved by proper activity or change of position, difficult to work with bending, if forced to bend, the lumbago increases, often like to use both hands to pound the waist to relieve the pain, a few patients have hip and upper rear thigh swelling pain. On examination, the spine generally looks normal, and there is no obstacle to pitch and tilt activities. There is pressure pain at the sacrospinous muscle on one or both sides, at the posterior part of the iliac crest or at the stop of the lumbar back muscle behind the sacrum. When the pain is severe, the movement is slightly restricted. The neurological examination is mostly abnormal, and the X-ray examination is mostly normal. sometimes changes in the physiological curvature of the spine are seen, such as scoliosis of the lumbar spine, reduced or absent anterior lumbar convexity, or congenital variants such as sacralization of the 5th lumbar vertebra, lumbarization of the 1st sacral vertebra, occult spina bifida, etc., or osteophytes are seen, but these osteophytes are not directly related to the onset of the disease. Treatment I. Identification and treatment Lumbar muscle strain is related to strain and has a high recurrence rate, so prevention should be the main focus. Treatment should avoid causative factors causing strain injury, patients need to self-care, while for those with obvious pain disease, the following methods can be used to regulate the treatment. This disease can be divided into cold-damp paralysis, damp-heat paralysis, qi-blood stagnation, and kidney deficiency. (A) Cold-damp paralysis and obstruction Cold pain in the lumbar region, unfavorable turning, no reduction in lying down, aggravated by cloudy and rainy days. White and greasy tongue coating, sunken pulse. The treatment is to dispel wind and cold, promote paralysis and remove dampness, warm the meridians and open the channels. (2) Dampness and heat paralysis Pain with heat sensation, aggravated by hot or rainy weather, relieved by activity, with red urine. The tongue is yellowish and greasy, and the pulse is moist and counted. Treatment is to clear heat and resolve dampness. (3) Stagnation of qi and blood. Low back pain like stabbing, with pain in a fixed place, light at day and heavy at night, with inconvenience in leaning and tilting at lighter times and inability to turn to the side at heavier times due to severe pain, refusing to press. The tongue is purple and dark, and the pulse is string. Treatment is to invigorate blood circulation, resolve blood stasis, promote Qi flow and relieve pain. The formula is Di Long San plus or minus. (D) Kidney deficiency. Soreness and pain in the lumbar region, unceasing, weakness of the legs and knees, like pressing and rubbing, worse in case of labor, relieved by lying down, often recurrent. In Yang deficiency, the face is white, the hands and feet are not warm, less breath and lazy, the waist and legs are cold, the tongue is pale, and the pulse is sunken and thin. In case of Yin deficiency, the heart is disturbed and insomnia, dry throat and thirst, flushed face, tiredness and fatigue, red tongue with little coating and thin pulse. In case of kidney yang deficiency, the treatment is to warm up the kidney yang, and the formula is Jin Kui Kidney Qi Pill and Kidney Blood Tonic plus or minus. In case of kidney yin deficiency, the treatment is to nourish kidney yin, and the formula is Zhi Bai Di Huang Wan and Da Teng Yin Wan with addition and subtraction. The commonly used technique is to rub and press the kidney, lumbar Yangguan, eight mash or lumbar pain area. For lumbar muscle weakness, focus on rolling and kneading, and for lumbar muscle spasm, focus on kneading and pushing the tendons, so as to achieve the purpose of relaxing tendons and activating blood, relieving spasm and pain. The external application method can be used to apply ointment such as wound and damp pain relief cream, dog skin cream, etc., and the Chinese medicine “Sizi San” can also be fried and ironed on the waist. Acupuncture Acupuncture points such as A-Yi, Kidney Yu, Wa-Yang-Guan, Wei-Zhong and Kun-Lun can be used in combination with moxibustion and warm acupuncture for those with deficiency of body and kidney energy. V. Physical therapy Infrared light, ultra-short wave, hot wax bath or Chinese medicine ion guide can be used to assist in treatment. Prevention and conditioning Avoid excessive bending for a long time, and enhance the functional exercise of the lumbar back muscles, such as supine five-point, three-point or arch bridge exercises, and also use the prone position of the swallow exercise. When the pain is obvious, you can hold the lumbar girth fixed, you can swim more exercise. Prognosis and regression Once chronic lumbar muscle strain is formed, the disease is protracted and difficult to heal, but if you can adhere to functional exercise, pay attention to rest, avoid strain and sprain, the disease can be expected to be controlled and the recurrence rate reduced.