lumbar muscle strain Lumbar muscle strain refers to an accumulative injury to the muscles and their attachment points in the lumbar region, leading to localized chronic aseptic inflammation. Its main clinical manifestations include chronic, dull pain in the lower back, exacerbation after repeated episodes, and worsening after exertion. Lumbar muscle strain is also known as "chronic lumbar strain," "lumbar myofasciitis," "functional low back pain," and so on. It is a significant cause of lower back pain, characterized by its chronic nature, long duration, and propensity for recurrence.

Lumbar muscle strain refers to the cumulative injury of the muscles and their attachment points in the lumbar region, leading to localized chronic aseptic inflammation. It is characterized by chronic, recurrent, and aggravated pain in the lumbar region, especially after exertion. Lumbar muscle strain is also known as "chronic lumbar strain," "lumbar myofasciitis," "functional low back pain," and so on. It is an important cause of low back pain, characterized by a chronic, long course, and a tendency to relapse.

Unhealed Acute Injuries

Following acute lumbar sprains, local muscles, ligaments, and other tissues are damaged. If left untreated or mistreated, the injury may not fully recover and may become chronic. Repeated minor lumbar muscle injuries can also lead to chronic lumbar muscle strain.

Chronic Inflammatory Response

Prolonged overloading of the lumbar region or prolonged poor posture can gradually lead to aseptic inflammation in the lumbar muscles, ligaments, and soft tissues.

This type of chronic cumulative strain can result from excessive lifting and fatigue in the lower back, prolonged poor posture in desk workers, prolonged bending and working in a bent position, and other forms of cumulative strain. This long-term cumulative strain causes chronic tearing of muscles and ligaments (commonly seen in the supraspinous ligament), leading to inflammatory responses, resulting in persistent and difficult-to-heal low back pain.

Congenital and Acquired Lumbar Vertebral Abnormalities

Conditions such as sacralization of the lumbar vertebrae, lumbarization of the sacral vertebrae, and spondylolysis, as well as acquired injuries such as lumbar vertebral compression fractures, dislocations, lumbar disc herniation, and spondylolisthesis, can cause imbalance in the lumbar muscles and ligaments, leading to chronic lumbar muscle strain.

The main triggering factor for lumbar muscle strain is excessive lumbar loading, leading to soft tissue damage in muscles, fascia, and ligaments. Prolonged sitting or standing, improper heavy lifting, and prolonged lumbar loading activities all contribute to lumbar muscle strain. Additionally, obesity is also a contributing factor. Research has also shown that smoking and alcohol consumption can increase the incidence of lumbar muscle strain to a certain extent.

Pain

Typically presents as recurrent, dull or aching pain in the lower back, which may radiate to the buttocks. Pain worsens with standing or twisting and is usually relieved to some extent by rest or changes in position. Pain can easily recur and may worsen with exertion or exposure to cold wind.

Other Manifestations

Include mild tenderness in the sacrospinal muscles on one or both sides, discomfort in the lumbar-sacral area, with generally no significant impairment of lumbar and leg movement, though severe cases may result in slight restriction.

Correcting poor lifestyle and work habits, avoiding prolonged sitting or standing, using proper lifting techniques, and reducing body weight all contribute to the prevention and treatment of lumbar muscle strain.

Engaging in appropriate physical activity or regularly changing positions can alleviate low back pain. Placing a small pillow under the lower back while sleeping can also alleviate symptoms. Wearing a lumbar support may be necessary. Strengthening exercises for the lumbar muscles should be performed under the guidance of a physician.

TCM believes that the etiology of lumbar muscle strain is due to "external pathogenic factors, delayed trauma, chronic strain, and internal deficiency of qi and blood, liver and kidney deficiency." Based on this, TCM treatment mainly involves the following aspects:

Internal Administration of Chinese Herbal Medicine

Treatment primarily focuses on nourishing the kidneys, supplemented by promoting blood circulation, expelling pathogenic factors, and promoting meridian circulation. However, the course of treatment for internal administration of Chinese herbal medicine is relatively long and prone to recurrence. It is usually combined with external application for more significant therapeutic effects.

Kidney Deficiency Type

For those with kidney yang deficiency, the treatment should focus on warming and tonifying kidney yang, using modified Bushen Huoxue Decoction. For those with kidney yin deficiency, the treatment should focus on nourishing kidney yin, using Zhibai Dihuang Pill, Dabuyin Pill, or internal administration of proprietary Chinese medicines for kidney and lumbar health.

Qi Stagnation and Blood Stasis Type

The treatment should focus on promoting blood circulation, resolving blood stasis, promoting qi flow, and alleviating pain, using modified Dilong Powder combined with Duzhong, Xuduan, Sangjisheng, and Gouji.

Wind-Cold-Dampness Type

The treatment should focus on dispelling wind, eliminating cold, and removing dampness, using modified Qianghuo Shengshi Decoction or Duhuo Jisheng Decoction.

Damp-Heat Type

The treatment should focus on clearing and resolving damp-heat, using Er Miao Decoction combined with Mugwort, Job's Tears, Rehmannia, Phellodendron, and Hedyotis.

External Application of Chinese Herbal Medicine

External application of Chinese herbal medicine for the treatment of lumbar muscle strain is characterized by its simplicity, convenience, economy, and effectiveness. Different dosage forms and methods are used to apply the medication to the local lesion or acupoints, directly targeting the affected area with remarkable therapeutic effects.

External application methods may include medicated oils such as Zhenghong Oil, Zhenggu Shui, and Guyuling, or external plaster applications such as Wound-Dampness Relieving Ointment, Baozhen Ointment, Qizheng Xiaotong Plaster, and Warming Meridian and Promoting Circulation Ointment.

Manual Therapy

In general, manual therapy for lumbar muscle strain involves similar massage and manipulation techniques used to treat lumbar sprains. For elderly patients, the manipulation should be gentle, especially regarding traction, to avoid adverse reactions. Manual therapy should be performed once every other day, with a course of 10 sessions. During the treatment period, patients should avoid exertion and exposure to cold.

Acupressure is applied to the lumbar and leg areas, followed by massage of the paraspinal muscles, and manipulation or tapping of the lumbar muscles or ligaments. In cases of necessity, excessive flexion and extension of the lumbar region or traction therapy may be applied. The manipulation should be light, smooth, flexible, and steady, avoiding excessive force to prevent aggravating the injury.

Acupuncture Treatment

Acupuncture, with its effects of regulating meridians, adjusting yin and yang, enhancing immunity, and improving constitution, has a wide range of clinical indications. As a prominent representative of non-surgical therapy, acupuncture has become an important means of treating lumbar muscle strain, with significant efficacy and minimal side effects.

Treatment methods may include acupuncture therapy, moxibustion, bloodletting, fire needling, needle-knife therapy, skin needling, electroacupuncture, floating needling, and others.

Strengthening the core muscles of the abdomen and lower back through physical exercise can help prevent lumbar muscle strain and provide protection for the spine. The "swallow pose" method can be used for lumbar muscle exercise: lying prone on the bed, arms at the sides, legs straight, then lifting the head, upper and lower limbs upward without bending the elbows and knees, maintaining them straight, resembling a swallow's posture. Repeat the exercise 20-40 times. Additionally, swimming, cycling, and brisk walking are excellent aerobic exercises that generally do not exert extra pressure on the back.

Using proper lifting techniques, such as squatting to lift heavy objects instead of bending at the waist, can help prevent lumbar muscle strain. If possible, wearing a lumbar support while lifting is advisable.

Maintaining correct standing and sitting posture and avoiding prolonged sitting or standing are important.

Quitting smoking and alcohol consumption, as these can lead to low back pain and degenerative spinal diseases.

Maintaining a healthy weight, as excessive obesity can add extra burden to the lower back and accelerate lumbar spine degeneration.

Keeping the lower back warm and dry, adjusting clothing according to changes in temperature.

Using a firmer mattress to maintain the normal physiological curvature of the spine.