Knowing More about the Different Types of Lower Back Pain and its Related Treatment Methods
Lumbago is a common disease in clinic. There are many reasons that cause lumbago. As the saying goes “Patient with back pain makes the doctor headache”. The injury of lumbosacral joint and soft tissue around, pathological injury and congenital or postnatal structural abnormalities are all its etiological factors.
Lumbago can be classified into 3 categories. 1. Acute waist sprain Acute waist sprain is a common disease in clinic, which is commonly called “twist waist”. The acute injury in muscle, anadesma, ligament and joint will cause intense pain, stimulated tension on waist muscle, and the limitation of motion of waist immediately. Invasion of wind, cold and dampness after injury will lead to chronic waist pain. Liable crowds: the young and manual workers. People who seldom participate in physical labor and participated it by chance are easy to be attacked by acute waist sprain. Clinical manifestations of acute waist sprain. There is a history of lumbar strain, and intense pain in waist of one side or two sides. The pain will be aggravated when moving the waist, cough, sneeze, or deep breathing. The muscle in waist is on a stressed state. Physical signs in clinical examination Pressure pain point: In the early stage of sprain, there is obvious local pressure pain. The obvious tension in muscle of waist may be touched. Observation on function of waist: limitation of activity in waist, especially for anteflexion, supporting waist with hands when walking, difficulty in turning the body over with decubitus position. Special examination: straight-leg raising test (+), pick-up test (+), X-ray examination: no obvious pathological change. 2.Lumbar muscle strain Lumbar muscle strain, one of the common reasons for chronic lumbago, refers to accumulated mechanical chronic injury of muscle and ligament of waist or chronic lumbago from the acute waist sprain without prompt or effective treatment. Clinical manifestations of lumbar muscle strain There is repeated vague pain in waist, aggravation after exertion and relief after rest, being difficult to bend from the waist, and aggravation of pain due to long-time bending from the waist. Proper movement or position change will relieve the pain in waist. Supporting the waist with a little pillow on it during sleep will relieve the symptom. Beat waist with hand will also relieve the pain. Physical signs in clinical examination There is usually no abnormal external appearance of waist. Sometimes the physiological front flex becomes superficial. For simple lumbar muscle strain, there are pressured pain points. straight-leg raising test(-), no abnormal in neurologic check. No obvious pathological change in X-ray examination. 3.Prolapse of intervertebral discs The degenerative pathological change in lumbar intervertebral disc, or the unbalance of interior and exterior force in lumbar intervertebral disc from external force will lead to a sudden disruption of annular fibrosus, and nucleus pulposus herniation of lumbar intervertebral disc. Then the disease occurred. Physical signs in clinical examination Abnormity in waist, limitation of the function of lumbar vertebrae, being sensitive to pressure and percussion accompanied with radiating pain. Straight-leg raising test (+), reinforced straight-leg raising test (+), bent neck test (+), straight-leg raising test of uninjured side：The ischiodynia will be induced by raising the uninjured leg implies that there is bigger central type protrusion in intervertebral disc. Before making a definite diagnosis on lumbar intervertebral disc protrusion, X-ray examination is needed to exclude the pains caused by other osteopathia, such as tuberculosis, tumor, et al.
[Treatment for lumbago] 1. Conventional treatment for waist sprain and lumbar muscle strain In western medicine, analgetica is taken orally and local blockage is used. The oral medicine of non-steroid anti-inflammatory drug, such as Indometacin is used to control symptoms. These kinds of medicines have poison and side effect, which may lead to gastric ulcer, gastric hemorrhage, et al. Local blockage is local injection with hormone. Long-term usage of hormone will cause endocrine disturbance and drug dependence. Treatment in TCM, the drugs for promoting blood flow to remove blood stasis and promoting qi circulation to relieve pain are being used. Tuina, cupping or acupuncture on waist may be used. But the therapeutic effects of TCM are slow and instable. 2. Conventional treatment for lumbar disc protrusion Absolute bed rest: get up for movement with waistline support after bed rest for 3 weeks. no bending of waist and picking up of object within 3 months. Continuous traction: to reduce internal pressure in intervertebral disc, enlarge vertebral canal volume, relieve the stimulation and pressure on nerve root. Physical therapy, tuina and massage: to relax the spasm muscle, further to relieve the internal pressure in intervertebral disc. Chemolysis for nucleus gelatinosus: Collagenase is injected into intervertebral disc or the part between dura mate spinalis and herniated macleos polposus. The enzyme will selectively resolve the nucleus gelatinosus and annular fibrosus without damage on nerve root, to reduce the pressure in intervertebral disc or diminute the herniated macleos polposus and relieve the symptoms. Operation: operation is very risky, for there are abundant blood vessels and nerves around the back bone. Failure of operation will lead to severe consequence such as palsy. The methods mentioned above will achieve effect on controlling symptoms, but not degeneration of lumbar intervertebral disc and annular fibrosus. Therefore, lumbar intervertebral disc herniation usually repeats. Meanwhile, all of the above medications and operation are risky and with certain poison and side effect. 3.Chinese Moxibustion used for corresponding diseases Not only waist sprain and lumbar muscle strain, but also lumbar intervertebral disc herniation, are suitable for Lumbago Moxibustion of Chinese Moxibustion. Lumbago Moxibustion may directly resolve the inflammatory edema of salient in intervertebral disc and stimulated nerve root to relieve or remove the stimulated oppression. The heat effect of moxibustion may accelerate the penetration of drugs into the local focus to alleviate the pain quickly. On the other hand, it may increase the local blood circulation and improve the nourishment for annular fibrosus to prevent repeated prolapse of nucleus gelatinosus. So it has resolved the basic etiological factors and controlled the reoccurrence of lumbar disc protrusion.
[Applicable scope] Lumbago Moxibustion is suitable for waist sprain, lumbar muscle strain, lumbar disc protrusion, hyperosteogeny and the secondary pain in waist and numbness in inferior extremity.
[Usage of Lumbago Moxibustion] Acute lumbar muscle sprain: Cold compress first for 1-2 hours after the occurrence of the sprain, then apply the plaster on the next day and paste it on the pain point directly. One plaster for 10 hours till relieved. When the pain disappeared, once a day for 10 hours till full recovery. Chronic lumbar muscle strain: Paste on the pain point or acupoints. One plaster per day for 10 hours. One week is one treatment course. Three treatment courses is a treatment stage. After 4 treatment stages, the reoccurrence of lumbago may be controlled.
For lumbar disc protrusion, not only the pain point but also the local focus shown on X-ray film should be chosen to achieve the effect of treating the symptoms and cause at the same time. For those patients who had received operation or tuina, moxibustion on the local focus may effectively prevent repeated rupture of annular fibrosus and repeated occurrence of the disease. For chronic lumbago: Besides plastering on local focus, pasting on Weizhong acupoint (UB 40) every night is needed. One plaster for 10 hours.
