Acute lower back sprain
Introduction
Introduction to acute low back sprain Acute lumbar sprains are commonly known as flashing waists in the folk, and are more common in clinical practice, especially in manual laborers; those who occasionally participate in sports or labor without prior preparation for physical activity are more likely to occur. Sitting in the office all the year round. The incidence of this disease varies greatly depending on the scope of treatment in each hospital, accounting for 5% to 20% of orthopaedic outpatient cases. However, the incidence of this disease has been significantly reduced in recent years due to continuous improvement of working conditions. Patients with acute lumbar sprains are more common in men than in women, with younger ages and younger and younger patients. Although the patients can be seen in all walks of life, more than 60% of them are heavy physical workers and athletes with a large amount of activities, and those who work hard by chance are also prone to occur. The pathological range of the disease includes the myofascial tissue of the lower back to the ankle, that is, the two anatomical regions of the thoracolumbar region and the lumbosacral region, but the clinical manifestations and treatment principles are basically similar, so they are now combined. set forth. basic knowledge The proportion of illness: 0.068% Susceptible people: no special people Mode of infection: non-infectious Complications: acute lumbar sprain
Cause
Causes of acute lumbar back sprain
(1) Causes of the disease
1. Unprepared activities: Whether it is physical labor or various competitive activities, if the spine and limbs can be slow to fast before the official start, from small to large preparation activities, it is not easy to damage (including the lower back) Sprain), on the other hand, sudden increase in spinal load during unprepared activities can cause sprains and ligament tears. In severe cases, fractures can occur (compared with transverse process fractures), especially during weekdays. And physical exercisers.
2. Poor posture: All sports have their own scientific training procedures. Both coaches and athletes should pay attention to and operate according to procedures, which can greatly reduce the incidence of waist injuries, but in daily labor, especially on weekdays. Family women or mental workers who are engaged in heavy physical labor are often accustomed to moving their bodies forward, bending their knees, bending their hips, and then holding them up when they encounter a heavier object. The normal steps of gradually stretching the knees and hips at the same time, so that the force is not properly applied, and the back is sprained.
3. Improper labor mode: Except for the forced labor position caused by different working conditions, it is difficult to correct, some workers can not master the correct labor mode, such as when driving the cart to pick up the patient, if not using "push" Instead, the "pull" method is used, because the longitudinal muscles of the paravertebral muscles are more likely to cause sprains in the lower back, and such actions are very common in daily life and work.
4. Improper cooperation: In the competition of labor or sports events in which two or more people participate together, if one of the actions is uncoordinated, it may easily cause another person's back sprain or other parts due to the deviation of gravity, especially in It is more likely to occur when mental and physical preparation is insufficient.
5. Other reasons: including falling from a height, slipping on the ground, traffic accidents or life accidents, etc., can cause sprains in the lower back.
(two) pathogenesis
The spine is a load-bearing strut structure. In the thoracic vertebrae, the thoracic ribs and the sternum form a protective effect on both sides and the front side, so the thoracic vertebrae are less prone to sprains, while in the lumbar vertebrae, there is no other bone scaffold support, and the front is a loose abdominal cavity. Therefore, the stability of the lumbar spine depends mainly on the ligament and muscle maintenance. If the shoulder is heavy, the body loses balance due to sudden factors such as slippery, jumping or crossing the ditch, and the heavy object generates strong tension or pressure through the leverage of the spine. The ligaments, fascia, muscles, and joint capsules attached to the lumbar spine are damaged, usually causing laceration at the ligaments and fascia-attached bones. At this time, most or part of the fibers are broken, and local bleeding, edema, and infiltration Out of pathological changes.
On the other hand, from the point of view of biomechanics, any activity in the lower back is restricted and coordinated by the mechanical relationship, and various actions are performed while maintaining the balance in the waist and the back, for example, when carrying heavy objects, if the objects are The weight, the lifting method and the force program are all compatible, so it is easy to complete: conversely, the weight or volume of the object is too large, the lifting time is too far from the midline, and the knee joint is not bent first, which not only increases the chest and waist. Segment and lumbar load, and paravertebral muscle tissue is also prone to sprain.
Prevention
Acute low back sprain prevention
About 50% of such injuries can be prevented by prevention. The main measures are as follows:
1. Preparation before labor: not only those who do not often carry out manual labor, but even workers who engage in manual labor every day should properly activate the lower back before the start of formal labor to reduce the occurrence of accidents; This is especially true for strenuous athletes.
2. Master the essentials of physical training (exercise): Any sport has its own scientific and anatomical and physiological requirements, and has been repeatedly revised to prove that it can improve athletic ability and prevent sports injuries. , including preparations before strenuous exercise, so you must follow the essentials for training, and do not cause damage due to your own.
3. Actions must be done in a decent manner: for all labor and sports, each person should act according to the individual's physical energy. Do not be reluctant to prevent losses due to accidents.
4. Waist protection: For activities with weak back muscles or strong activity, the waist and back should be protected with a wide belt in advance to increase the back muscle strength, just like the wide strip worn by weightlifters or wrestlers. The same as the waist.
Complication
Acute lumbar back sprain complication Complications acute lumbar sprain
Many sprained backs are difficult to cure in a short period of time, and even if cured temporarily, the recurrence rate is quite high. Therefore, the sprained back is more afflicting than other diseases, consuming a lot of time and huge health care resources, but the cause of the disease is often unclear. Many people suffer from continuous or intermittent episodes of back and back sprains, which affects work and life, reduces the quality of life, and even loses their ability to work.
Symptom
Acute lumbar sprain symptoms common symptoms thoracolumbar and lumbar lordosis disappeared forced posture sprain lower limb radiation pain bedridden
1. Forced position: the most common, and the degree is different. Among them, severe cases can be bedridden. Generally, the cases of sprained back and back can get up and down, but the patient's thoracolumbar and lumbar vertebrae The lordosis disappears and presents a forced position to flexion to the affected side, which is actually a defensive reflex of the body to protect the affected muscle group from the continuation of tensile stress.
2. Pain: Because most of them are sudden injuries, the patient's conscious local pain is very intense, and it is aggravated by local activity and vibration. After lying down, it can be relieved. The pain points are fixed and the parts of the muscle are torn. Consistently, it is more common in the posterior superior iliac spine and the thoracolumbar spine. It can also be seen in the paravertebral transverse process. The tender point is obvious and limited. Sometimes it can be radiated from the pain point to the back of the thigh and is aggravated with the increase of abdominal pressure. The conduction pain is mostly negative, and has no obvious relationship with the lower limb lift (in bed examination), and the pain can be alleviated after partial closure.
3. Restricted activity: The lumbar back activity is obviously limited by the increase of the tensile stress of the damaged tissue, which is especially limited by the lateral curvature, rotation and flexion to the healthy side. Relax the damaged tissue, so you can still do small-scale activities.
4. Muscle spasm: The damaged muscles have reflexive sputum due to pain and various other pathological factors. They are touched by hand and are generally obvious. The muscles in the squat state are frequently contracted due to muscle fibers. Increases the amount of metabolites, which can exacerbate the pain and re-inflame the muscles, causing a vicious circle, so try to block it.
5. Others: In addition to paying attention to the positive signs and symptoms, the disease is easily confused with lumbar disc herniation, so it should pay attention to the negative signs that are not easy to appear in this disease, such as the neck test, lower leg straight leg raising test, Abnormalities in lower limb reflexes should be checked.
Examine
Acute low back sprain
X-ray plain film mainly shows the disappearance of the lower chest and lumbar lordosis and lateral curvature, generally without other changes, MRI examination can show the extent and extent of muscle damage, can be used as appropriate, CT examination is only used with Osteoarticular injury.
Diagnosis
Diagnosis and diagnosis of acute lumbar sprain
Diagnostic criteria
1. History of trauma: The back muscle sprain should of course have the basic condition of traumatic history of trauma, but in addition to the obvious trauma, it is easy to be noticed by the patient. Some minor traumas, such as improper force when the bed is turned over, are by sitting or squatting. If you stand too hard when you stand up or when you take things from a height, the balance of posture is imbalanced, etc., it is easy to be ignored or forgotten, so you should pay attention to the inquiry.
2. Clinical manifestations: including the aforementioned forced position, pain, tenderness, limited mobility and back muscle spasm, etc., should be carefully examined and judged.
3. Closed test: Take 0.5% to 1% procaine 10~20ml to seal the pain point. After injection, local pain (including radiation pain behind the thigh) is immediately relieved or disappeared, which is positive; no obvious change It is negative, which can be used not only for the diagnosis of sprain of the lower back, but also for the identification of lumbar disc herniation. The lower extremity radiation pain caused by lumbar disc herniation is radiated along the sciatic nerve, and there is no change after closure. Some patients with sprained back muscles may have similar lower extremity radiation pain, but they are reflexive, with a small range, no signs of sciatic nerve being pulled, and disappear after being closed.
4. Imaging examination: X-ray plain film mainly shows the disappearance of the anterior chest and lumbar lordosis and lateral curvature, generally without other changes, MRI examination can show the extent and extent of muscle damage, can be selected as appropriate, CT examination Only for those with bone and joint injuries.
Differential diagnosis
The disease should be differentiated from lumbar disc herniation. See the main points.
In addition, the disease should be noted with the identification of thoracolumbar ligament rupture, transverse process fracture or other injuries.
