Chronic strain low back pain often has a long history, mostly manifests as continuous chronic low back soreness, stiffness, pain and other uncomfortable feelings, the symptoms exist for a long time and can be aggravated by acute attacks, often manifests as symptoms aggravated with weather and seasonal changes, the lumbar area likes warmth and fears cold, there is symptomatic improvement and comfortable feeling when applying heat and pressure, and the symptoms are mainly lumbar symptoms without lower limb symptoms, there is no leg and foot discomfort, there is no urinary or fecal disorder, the imaging X-ray of the lumbar spine only shows mild to moderate degeneration, CT and MRI show no disc and spinal canal lesions, etc. There is no discomfort in the legs and feet, no urinary or fecal disorders, and the imaging X-ray of the lumbar spine only shows mild to moderate degeneration, and CT and MRI show no disc or spinal canal lesions.
Treatment principles: The main purpose is to eliminate the cause of the disease, relieve pain and spasm, eliminate inflammation and wind, coordinate and balance and prevent recurrence.
1.Elimination of causative factors: chronic strain back pain is mainly related to poor living habits and the body being in the same fixed posture for a long time in life and work, so the treatment should understand the patient’s living habits, work characteristics, and correct the poor living habits and posture, etc.
2, rest: for acute lumbar sprain caused by trauma, to achieve absolute bed rest, generally need 2-3 weeks, and so on until the injury tissue completely recovered. The best rest to take the basic lumbar non-weight-bearing position, such as supine flexed hip and knee position, can make the lumbar muscles completely relaxed.
3, heat therapy: In addition to the initial days of acute injury, the general use of local heat therapy, can make the patient muscle relaxation, increase blood circulation and lymphatic reflux, reduce pain. It can be placed in the lumbar area with wet heat Chinese medicine cloth bag for heat therapy, that is, with Chinese medicine (angelica, red peony, wind, cow knee, cinnamon branch, qiangwu, Wujiapi, wei lingxian, moxa and transverse bone grass, 100-150g each) in a cloth bag sealed, add appropriate amount of water decoction, to be warmed, you can put the bag on the lumbar pain. Before treatment, the skin of the wet compress should be coated with petroleum jelly to prevent burns. Each time 20-30 minutes, 1-2 times a day. Other treatments such as wax therapy, short-wave diathermy, hot water bath, steam bath and acupuncture can also be selected for application.
4.Massage and manipulation therapy: massage is very effective in the treatment of soft tissue low back pain.
(1) operating principles: from the sacrococcygeal area from the bottom up to the waist, chest, neck massage. Massage parts are along the midline of the spine on both sides of the muscle in turn upward. Massage power to make the patient’s situation, to the light and heavy pressure and mo hands method, to make the patient feel light and comfortable, do not violence. In addition to massage along the spine on both sides of the muscle fascia, can also be in some important parts of the pressure massage to increase the therapeutic effect.
(2) operation method.
Knead: take a sitting posture, both hands five fingers together, respectively, placed on the left and right lumbar vertebrae, palms inward, slowly rubbing up and down, until hot.
Rolling: fist in both hands, put the waist to roll around, massage, from the bottom up, from top to bottom, repeatedly. The head can be tilted backwards and forwards.
Push: after the two hands are rubbed together and heated, overlap and put in the middle of the lumbar vertebrae, push and rub from top to bottom 30-50 times, until the local heat sensation.
Pressure: two hands crossed waist, thumbs pressed at the lumbar eye, squeeze, and rotate and knead, first clockwise, then counterclockwise 36 turns each.
Pinch: sit with both feet extended, or bend the knees, or sit in a sitting position. Both hands pinch, lift and release the lumbar muscles 15-20 times.
Knock: Make a fist with both hands, with the palms of both fists facing outward, and knock lightly on the waist in order not to cause pain, left and right at the same time, 30 times each.
Grasping: Both hands cross the waist, thumbs in front, press on the waist side without moving, the remaining four fingers from both sides of the lumbar vertebrae, grasp the skin outward with the belly of the fingers, from the waist eye to the tail, both hands at the same time, each grasp 36 times.
Shake: place both hands at the waist, press the lumbar eye with the palm root, and shake the palms inward and up and down rapidly 15-20 times.
Press: in a seated position, press the left or right middle fingertip for 1-2 minutes.
Point: Take a sitting position and press the point on each leg (after the knee joint) with the tips of the fingers of both hands for 1-2 minutes until the pressed part feels sore, numb and swollen.
5.Pharmacotherapy: Oral painkillers such as fenbid, celebrex, mupirocort, ibuprofen, etc. can be taken, or local painkillers can be sprayed. Muscle relaxants such as Myona tablets (ethylparisone hydrochloride). Vitamins and energy medications. Non-corticosteroid drugs can also be used as appropriate.
6, liquid closure therapy: acute and chronic soft tissue injury lumbago are effective.
(1) shallow closed therapy: for shallow pain, the patient prone position, the injection needle directly into the pain point, and gradually inject the numbing agent evenly infiltrated around. After injection, use the original puncture needle and then inject prednisolone acetate 25mg, generally closed for 1 time that is effective, if there is still pain, can be injected again at intervals of 5 days, 2 times or 3 times for a course of treatment.
(2) deep closed method: applicable to near spinal bone deep soft tissue pain, such as deep muscles, small joint synovial bursa, deep ligaments, etc.. First, the small joint capsule closure therapy, injecting anesthetic into the small joint capsule around, once every 5 days, a total of 2 or 3 times a course of treatment. The second is the closure method of the 3rd lumbar transverse process syndrome: a thin and long injection needle is stabbed at 25px lateral to the painful end of the 3rd lumbar transverse process, and anesthetic is injected into the area.
7, adjuvant therapy: functional exercise, strengthen the lumbar back extension muscle exercise, such as supine arch bridge exercise, prone position of the swallow type exercise.