What happened when you bent down?
One is the pain in the muscularis and ligaments of the waist. This kind of low back pain is often confined to the muscles of the original injury site and extends as far as the buttocks or thighs. Most of the reasons are muscle strain, strain caused by chronic fatigue, muscle stiffness and fibrosis. Muscle pain is manifested as pain caused by fatigue, swelling and pain caused by strain and contusion. Pain often occurs during or after rest, such as waking up in the morning or sleeping until midnight. Generally speaking, this kind of low back pain can still stand or walk like a normal person, but it will begin to appear when you are sedentary or overworked.
Another kind of low back pain is caused by the compression of the spine or spinal nerves. This kind of low back pain is mostly caused by the waist pulling the hips, thighs, calves and even toes, which occurs unilaterally and rarely on both sides at the same time. The feeling of pain is mostly pain in the waist, buttocks and thighs, and most of them are pain, weakness or numbness in legs and feet. Pain usually occurs after walking or standing 15 minutes, and the patient must find a place to sit down. There are spinal nerve branches extending on each side, and the size of intervertebral foramen space is fixed. When we stand, due to gravity and erector spinae contraction behind the spine, if the intervertebral foramen becomes smaller due to bone spurs or disc herniation, it will stimulate the spinal nerves.
Especially in the waist and sacrum, the nerve extending from the lumbosacral joint (between the five lumbar vertebrae and the sacrum) is the easiest to be compressed, accounting for about 70% of the spinal nerve compression. Symptoms other than lumbago and leg pain can cause abnormal sensation of numbness of superficial nerves in the affected calf and dorsum of foot, which makes people feel uncomfortable. When patients' toes are raised, it is difficult for their heels to touch the ground. If the nerve roots of the fourth and fifth vertebrae of the lumbar spine are pinched, the thumb, the second finger of the foot and the front of the tibia will feel abnormal numbness of the epidermis, making it difficult for patients to lift the toes of their heels, accounting for about 25%. Clinically, many patients have spinal nerve compression of the above two joints at the same time. If the nerve between the third and fourth lumbar vertebrae is compressed, there will be muscle atrophy of the thigh or numbness of the epidermal nerve in the front and inner thigh. The above diagnosis can be compared with the healthy side.
Check whether the nerve heel is stuck can be known by the following methods: make the patient lie flat, straighten his legs, and actively lift the affected lower limb to the highest limit. The average person's leg lift angle can reach a right angle of 90 degrees, at least 70 degrees or more. If it hurts when lifting the leg or can't be lifted to the standard height, the nerve root will be pulled when lifting the leg, so the unsuccessful lifting of the leg means that the nerve root is clamped, which is the so-called "straight leg lifting test". On the other hand, the patient is ordered to lie on his side, bend his knees and shrink his legs, and extend his calves on the healthy side. The doctor can touch the sciatic nerve between the affected buttock, buttock and ischium. If the nerve root is compressed, the compressed sciatic nerve will have obvious pain response than the healthy side. A simpler method is to let the patient stand with his feet on the chair. This position can also easily touch and press the sciatic nerve according to the above positioning method.
The pain of the first kind of lumbar muscle membrane is mostly caused by lumbar scoliosis caused by sudden exercise, excessive exercise, acute lumbar sprain, chronic lumbar muscle strain or poor posture. Long-term abnormal contraction of lumbar muscles will lead to stiffness and fibrosis of lumbar muscles, which is also the culprit of chronic low back pain. Chinese herbal medicine (note 1) can be used to steam waist and massage acupoints. Acupoints Dachangshu, Xiaochangshu, Shenshu, Zhi Zhi, Weizhong and Chengshan can be used to relieve muscle fatigue and stiffness by Cao Qing Ointment (Note 2), electrotherapy, moxibustion and acupuncture. Combined with oral administration of traditional Chinese medicine, treatment based on syndrome differentiation has certain curative effect. In clinical application, people with backache, weak qi and blood, and cold hands and feet can add and subtract Achyranthes bidentata, Eucommia ulmoides and Rhizoma Drynariae with Shiquan Dabu Decoction, and women with osteoporosis can take Guilu Erxian Glue or Placenta Hominis Powder, all of which have good benefits. For patients with kidney-qi deficiency or chronic lumbar muscle strain, Huanshaodan can be used as the main prescription, which can be added or subtracted according to the symptoms. Duhuo Jisheng Decoction and Sanbi Decoction can be used for those with severe pain, Shu Jing Huoxue Decoction and Li Shujing 'an Powder for those with strong constitution, and Danggui Niantong Decoction and Guizhi Shaoyao Mu Zhi Decoction for those with inflammation and fever similar to rheumatoid arthritis.
If the second kind of pain caused by nerve root compression is mostly caused by lumbar disc herniation (HIVD), lumbar hyperplasia (lumbar spur) or lumbar lordosis, it is all caused by the stimulation of the intervertebral foramen where the spinal nerve root is located. Stimulated nerve roots will produce inflammation and swelling, and even occupy the intervertebral foramen space to make the compression more serious. Spinal spondylolisthesis is a phenomenon that the articular process of the W-shaped bone behind the upper and lower vertebrae is unstable and the vertebral body slides forward. Not only the spinal nerves are affected, but also the spinal nerves in the spinal cavity are sheared by the vertebral holes of the upper and lower vertebrae, which can cause atrophy and paralysis of the lower limbs and various nerve compression symptoms. Clinically, the severity of spondylolisthesis is divided into four stages, which can often be clearly seen by lateral X-ray photography of lumbar spine.
Low back pain caused by nerve entrapment should be treated conservatively. You can take Xuefu Zhuyu Decoction, Shu Jing Huoxue Decoction, Radix Aconiti Kusnezoffii, Olibanum, Myrrha and other traditional Chinese medicines first, but the effect of oral Chinese medicines alone is not good. Lumbar traction and stretching should be used to increase intervertebral foramen space. Before traction and stretching, it is necessary to have enough hot compress and massage the waist to soften the muscles, so as not to strain the muscles and achieve the effect of opening the joint space. Wear a tight belt with braces at ordinary times, which can effectively reduce and disperse the pressure on the lumbar spine and avoid protruding and proliferating tissues from stimulating nerve roots. When the nerve root is not stimulated, the nerve root will naturally expand, the intervertebral foramen space will increase, and the degree of nerve compression will also be reduced. If spondylolisthesis is serious, the patient should be advised to operate. Before the operation, a hard back frame, commonly known as "iron clothes", can be temporarily used to increase the support for the spine, but lumbar traction is not allowed to increase the degree of slippage.
Use a belt or hard back frame, only when standing, walking or sitting, not when lying down. If conservative treatment is effective, patients should be told not to carry heavy objects in the future. If they feel pain in their back and legs, they should put on a waistband quickly, which can often relieve low back pain quickly. When there is still no obvious curative effect after three months of treatment and the quality of life is affected, surgical treatment should be considered, and patients with lumbar spondylolisthesis suggest that surgical treatment is a better consideration.
Note 1
Medicine washing prescription: 5 yuan of Artemisia argyi, safflower 1 yuan, 2 yuan of angelica tail, 2 yuan of Chuanxiong, 2 yuan of Erythrina bark, all boiled in water, and fumigated the affected area with towel or steam while it was hot.
Note 2
Cao Qing ointment prescription: Ruyi Huangjin Powder (Rhizoma Arisaematis, Radix Glycyrrhizae, Pericarpium Citri Tangerinae, Cortex Magnolia Officinalis, Rhizoma Atractylodis, Radix et Rhizoma Rhei, Radix Angelicae Dahuricae, Cortex Phellodendri, Rhizoma Curcumae, and smallpox).