I. Concept
Lumbar muscle strain is a common lumbar disease, refers to the lumbar side or both sides or the middle of the pain, both as a symptom of a variety of diseases, but also as an independent disease, the essence of the lumbar muscle and its attachment point of the fascia, ligament or even periosteum of chronic injury inflammation. It can be seen in modern medicine as kidney disease, rheumatism, rheumatoid disease, lumbar strain spine and trauma, gynecology and other diseases. It is also called “functional lumbago” or “lumbar back fasciitis”, etc. Among chronic lumbago, this disease accounts for the largest proportion.
Causes
1, trauma: acute lumbar sprain is not properly treated or incompletely treated, and becomes chronic lumbar injury.
2, long-term repeated excessive lumbar movement and excessive load. Such as long periods of sitting, standing or from the bent position to the upright position holding heavy objects, lifting objects can make the lumbar muscle in a long-term high tension state, over time can lead to chronic lumbar muscle strain.
3.Congenital deformity. Such as unilateral lumbar sacralization, hypertrophy of the transverse process or asymmetric development of the small joints on both sides of the lumbar vertebrae can cause the lumbar region to lose its normal stability and pain.
4.Climate environment. Chronic lumbar muscle strain and climate and environmental conditions also have a certain relationship, the temperature is too low or humidity is too large can promote or aggravate the lumbar muscle strain.
There are three common etiologies.
1, chronic injury to the supraspinous and interspinous ligaments. The vast majority of patients have a history of injury and feel soreness and weakness in the lower back when bending, or a sense of rupture in the lower back; some patients can be accompanied by discharge pain to the buttocks, but no motor or sensory impairment. The pressure pain is often confined to the superficial tissues on and between the spinous processes of lumbar vertebrae 4 and 5 or lumbar 5 and sacral l. Sometimes a sense of ligament stripping and nodules can be palpated at the lesion, and there is no bone lesion on lumbar spine X-ray examination.
2, lumbar degenerative spondylitis. Mostly occurs in middle-aged and elderly people, lumbar pain is not all from the proliferation of “bone spurs”, but mainly from muscle, fascia, ligament, posterior joint strain or disc tissue or dura mater and spinal nerve, “bone spurs” can make the movement of the lumbar region is restricted, in clinical performance The “spur” may restrict the movement of the lumbar region, which may be clinically manifested as difficulty in movement. X-ray examination can reveal “bone spur” and changes in physiological curvature and intervertebral space.
3.3rd lumbar transverse process syndrome. The 3rd lumbar vertebra is located in the center of lumbar activity, and is the most prominent place of lumbar physiological protrusion, becoming the hub of lumbar forward flexion, back extension, left and right lateral bending and left and right rotational activities, and its two sides of the transverse process end is under the greatest stress of tension. In addition, because the anatomical transverse process of the 3rd lumbar vertebra is the longest, the lever force is also the largest, and there are lumbar square muscle, intertransverse process muscle, transverse process spine muscle, sacral spine muscle, deep layer of thoracolumbar fascia, intertransverse process ligament and other tissues attached to the top, the movement of the lumbar in any direction makes the top of the transverse process of the 3rd lumbar vertebra bear repeated pulling and grinding, so there are more chances to cause injury. The disease is mostly seen in young adults, with chronic, intermittent soreness, pain, and weakness in the lumbar region, the symptoms are not heavy, the soreness is widespread, but the specific pain points are not clear, the symptoms are not necessarily eliminated after sufficient rest, and the lumbar region is easily fatigued with annoying discomfort. It is difficult to maintain a single posture for a long time. After sitting or standing for a long time, it is only slightly easier to stretch the waist and change the position; the local symptoms of the waist are obviously aggravated after labor, and the pain can be dissipated to the buttocks and inner thighs. In rainy days, the symptoms are aggravated, and in sunny weather, the pain can be relieved.
Pathology
1, weight bearing: when people are active, the lumbar position is lower and the gravity is greater, which leads to the most concentrated force on the lumbar region. The stability of the trunk mainly lies in the spine, when the spinal structure is destabilized, the lumbar back muscles, which play an auxiliary stabilizing role, will work overload to achieve trunk stability, over time, the muscles produce compensatory hypertrophy, hyperplasia. In addition, long-term incorrect lumbar posture will also lead to continuous tension in the lumbar muscles, so that small blood vessels under pressure, insufficient oxygen supply, metabolites accumulate, stimulating the local and the formation of damage inflammation.
2, nutrition: because of the ligaments, fascia, muscle at the beginning and end of the low back vascular less, poor blood circulation, once the injury occurs, the repair and healing is slow. On the other hand, the frequent activities of the spine also affect the speed of healing, so that the local tissue injury lesions and pain persist for a long time. Even if the injury is healed, the scar tissue is not structurally strong enough to cause a recurrence of low back pain once the spine loses its balance when moving or bearing heavy objects, and the leverage of the spine can act on the injury.
The main pathology: muscle fiber degeneration, or even a small number of tears, forming scars or fibrous cords or adhesions, leaving long-term chronic low back pain.
IV. Performance
The patient has a history of long-term low back pain with recurrent attacks. The pain on one or both sides of the lumbosacral region is uncomfortable, sometimes light and sometimes heavy, and lingering. The pain is aggravated after exertion, and the pain is aggravated when bending over for a long time. After resting, the pain decreases and is related to weather changes. In acute attacks, all kinds of symptoms are significantly aggravated, and lumbar movement is limited. There is no abnormality in the appearance of the lumbar region, and there is no obstruction in the movement of the back. In a few patients, the lumbar movement is slightly restricted and there is pressure pain, which is mostly at the sacrospinous muscle, the stop of sacrospinous muscle behind the sacrum, or the posterior part of the iliac crest, or the transverse process of the lumbar vertebrae. x-ray pictures are mostly free of abnormalities, but a few patients may have osteophytes or spinal deformities.
According to traditional Chinese medicine, the waist is the capital of the kidney. Due to strain on the kidney or weakness of the kidney, the essence of the kidney is unable to nourish the tendons and meridians, so the affected area is often suffering from poor blood flow or blood stasis in the meridians, and the blood does not honor the tendons and the tendons are not relaxed, resulting in painful tendon contractures in the waist. If the kidney is weak, wind, cold and dampness can easily take advantage of the weakness and invade for a long time, and the tendons and muscles tend to become flaccid and weak.
V. Treatment
(A) Basic principles
1. Prompt diagnosis and identification of the cause.
2, treatment is mainly non-surgical treatment, such as a variety of non-surgical treatment is ineffective, surgical treatment can be implemented.
3, a single method is better than a comprehensive approach, or lumbar muscle strain is not yet very special treatment.
(II) Conventional treatment
1.Acute attack period or when the pain is heavy
(1) bed rest, lumbar braking.
(2) anti-inflammatory and analgesic drugs.
2.Chronic period
(1) lumbar circumference protection, pillow padding.
(2) functional exercise of lumbar back muscles.
(3) with drugs, physical therapy, acupuncture, massage, etc.
(C) common methods
1.Western medicine.
Mainly non-steroidal anti-inflammatory analgesics and analgesics, such as Fenbid. Mainly pay attention to the side effects of drugs. Pain point clear moment local closed treatment.
2.Chinese medicine.
Lumbar muscle strain in Chinese medicine is considered to be caused by cold and dampness, dampness and heat, qi stagnation and blood stasis, kidney deficiency or fall and trauma. The pathological changes often show the characteristics of kidney deficiency as the basis, feeling external evil, fall and flash as the standard. First of all, it is advisable to distinguish between deficiency and heat. Generally, those who feel the external evil, the evidence is more of the table, the real, the onset of the sudden and urgent, the treatment is appropriate to dispel the evil, according to the cold and damp, damp and heat, respectively, treatment. Those who are caused by kidney essence deficiency, the evidence is mostly internal and deficient, and chronic recurrent attacks are common. The clinical treatment can be divided into 1) cold-damp type; 2) damp-heat type; 3) kidney deficiency type; 4) blood stasis type. Commonly used formulas include: Gan Jiang Ling Shu Tang (Zhang Zhong Jing, “Jin Kui Yao”) or Dou Wu Zai Sheng Tang (Sun Simiao, “Qian Jin Fang”); Si Miao San (Zhang Bing Cheng, “Cheng Fang Yi Yuan”); Zuo Gui Wan (Zhang Jiebin, “Jing Yue Quan Shu”); Tonifying the Kidney and Strengthening the Tendons (Qian Xiuchang, “Wound Medicine Tonic”), etc. Various ointments can also be used externally.
3.Manipulation.
In the acute period, use less or cautiously use manipulation, and in the chronic period, use kneading, pointing, flicking, pinching, rolling, pulling and other manipulation.
4, acupuncture.
Acupuncture is taken from the A-Ye point, Kidney Yu, Zhi-Mu, Qi-Hai Yu, Life Gate, Lumbar Yang-Guan, Sub-S, and Wei-Zhong, etc. Fire cupping can be added to the lumbar points to disperse blood stasis and warm the meridians to relieve pain. Or ear acupuncture to prick the lumbosacral area, Shen Men area, kidney area, etc.
5. Exercise.
Mainly lumbar back muscle exercise to promote the flow of qi and blood and enhance the strength of the lumbar muscles. It can be done by front and back, left and right side flexion, wind swinging lotus leaf, supine leg raising, flying swallow pointing water and other gong, and can be combined with radio exercises, taijiquan, backward walking, etc.
6.Physiotherapy.
For chronic lumbar muscle strain can be carried out a variety of physical therapy.
Six, prevention
1, to prevent moisture, cold and cold. Do not sleep in a damp place at will. According to the change of climate, add clothes at any time, and after sweating and rain, replace wet clothes or dry your body in time. When it is cold, use electric blankets or sleep on a hot bed.
2, acute lumbar sprain should be actively treated, rest at ease, to prevent the transformation into chronic.
3, sports or strenuous activities, to do a good job of preparation activities.
4, correct poor work posture, such as bending too long, or ambling too low, etc.. After sitting or standing in the same position for a long time, should relax the waist, or stretch the waist, it is best to rest a few minutes every hour of work.
5, to prevent overwork. People are like a machine, excessive operation or overload use, will inevitably lead to damage to certain parts or the entire machine. Waist as the center of human movement, overwork, is bound to cause injury and lumbago, so pay attention to the work or labor in the labor and leisure.
6, the use of hard board upholstered bed. Sleep is one of the important part of people’s lives, the suitability of the bed or not directly affects the health of people, too soft mattress can not maintain the normal physiological curvature of the spine, so it is best to add a 10 cm thick cushion on the board.
7, pay attention to weight loss, weight control. The body is too obese, is bound to bring extra burden to the waist, especially the middle-aged and women after childbirth, are easy to gain weight period, appropriate diet, strengthen the exercise is necessary.
8, abstain from sexual intercourse. “waist for the kidney of the house”, too frequent intercourse is bound to damage the kidneys, kidney deficiency is waist pain.
9, labor. Incorrect labor posture, easy to cause lumbar muscle strain. Such as carrying heavy objects, as close as possible to the side, bending or twisting waist to be as careful as possible.
10, do at least 30 minutes of whole-body exercise every day, such as swimming, brisk walking, jogging, bicycling, etc. These exercises can enhance the function of the whole body and help stretch the joints and muscles.