Low back pain is an extremely common disease, “nine out of ten people have low back pain” shows its widespread; low back pain is also an extremely hot disease, “patient back pain, doctor headache” shows the difficult road to seek medical treatment. The incidence of low back pain is second only to the cold. However, its disability rate is much more serious than that of the cold. The consultation rate of low back pain in our orthopedic clinic is as high as 40%.
(I) Etiology.
There are numerous causes triggered by patients with low back pain, and today, the following are seen (typhoid/cold/static/retro).
(1) long-term incorrect work posture and poor living environment, especially long-term constant repetition of bending, upright this action, resulting in muscle tissue ischemia, hypoxia, degeneration, hypertrophy, stimulation of nerve endings triggering pain and pain. Such as miners, farmers.
(2) Not thorough, not timely treatment of lifting heavy objects not concordance and caused by lumbar muscle injury.
(3) sedentary people lumbar back muscles, gluteus continuous tension. Such as playing mahjong, watching TV, playing computer, long reading, car people, sitting on the sofa, sleep (seat) dream, knitting sweater; long wearing high heels, pelvis light forward, lumbar back extension, forcing the lumbar back muscle continuous tension; have occupational habits. Such as accountants, teachers, clerks, turners.
(4) Cold and humid environment: such as those who work and live in a cold and humid environment; as well as open-necked dresses, waistless dresses, winter dresses, etc.
(5) Those who have bad habits such as smoking and alcoholism, whose changes on blood flow have been mostly reported.
(ii) Clinical manifestations of low back pain.
The most common causes of low back pain are lumbar muscle strain without organic lesions and dorsal myofasciitis. Soreness, distension, sleepiness and pain are mostly in the back and lumbosacral region. It is aggravated by cold, rain, waking up and exertion; it can be alleviated by rest, slight activity, change of position and light tapping. The pressure pain is scattered. Sometimes the pain can be reflected or involved in the neck, shoulder or hip and thigh.
(iii) Differentiation.
Differential diagnosis of low back pain.
In low back pain, cases with low back pain as the main clinical manifestation and organic lesions should be strictly distinguished, and their pain can be stopped after removing the etiology. Otherwise, treatment will be delayed. Such as lumbar disc herniation (lumbar pain + leg pain and over the knee), lumbar spinal stenosis (lumbar and leg pain + intermittent claudication) thoracic spinal stenosis (back pain + high incomplete paralysis), extraspinal tumor (paraplegia + ascending sensory loss), thoracic and lumbar intervertebral infection (severe pain + persistent + persistent), thoracic and lumbar tuberculosis (thoracic and lumbar stiffness + abscess), pear-shaped muscle syndrome (hip pain + sciatica), third lumbar transverse process syndrome (3 transverse process pain + thigh pain), lumbar sacralization (lumbar pain +/- leg pain), etc.
(iv) Treatment.
Proper evaluation of conservative treatment of low back pain.
(1) Timely and correct removal of incorrect posture, habits and bad habits in work and life.
(2) Bed rest for up to 2 weeks in the acute stage.
Biomechanical research proves that half Fowler position (supine with both hips and knees flexed and a thin pillow under the knees) or side lying with knees and hips flexed and a pillow between the legs can obviously release the tension of the intervertebral discs and lumbar muscles; prone position is not desirable.
Chronic low back pain should not be bedridden.
(3) Traction: Its mechanism and effect lack scientific conclusion so far, but it is widely used in clinical practice. In the acute stage, fixing the patient to rest on a traction bed and light but continuous traction can loosen the muscles, release the spasm and relieve the internal pressure of the intervertebral disc. However, chronic low back pain is considered ineffective by systematic literature study.
(4) Massage is a traditional treatment for low back pain. Suitable techniques can provide short-term relief of pain and suffering, loosen muscle spasm and passively move joints, and have short-term effects. The long-term efficacy for chronic low back pain is still controversial.
(5) Acupuncture can “unblock the meridians and channels” and “regulate the qi and blood.” .
(6) Physiotherapy: its wide range of cold, heat, sound, light, magnetic field, mechanical, etc., is the main treatment means of various sanatoriums.
(7) Transcutaneous electrical stimulation: transcutaneous nerve (acupuncture point) electrical stimulation analgesic effects and methods, the effect is indeed, commonly used.
(8) Closure therapy: local closure has “needle to disease” effect on limited low back pain, which is both diagnostic and therapeutic, widely used, and very effective.
(9) peri-waist: it can not only brake, but also relieve pain, also can tighten the abdominal wall to increase abdominal pressure, prevent the lumbar vertebrae from flexing forward, and together play a role in supporting the lumbar vertebrae. But long use can cause lumbar muscle disuse atrophy.
(10) chronic low back pain of the lumbar back muscle exercise is a once and for all hope project (for simple lumbar vertebral compression fracture before 2 weeks and the best way to reset), he for chronic strain of the lumbar back muscle (degeneration) is the most fundamental treatment measures.