Low back pain

　　The causes of low back pain are diverse, and may be related to acute ligament injury or muscle strain, with a tendency to be self-limiting, or related to chronic osteoarthritis or ankylosing spondylitis in the lumbar sacral area. The incidence has a trend of increasing with age, reaching 50% in people over 60 years old.

　　Low back pain can be affected by various factors such as long-term insufficient sleep, fatigue, physical weakness, social psychological problems, and emotions. These factors often change the patient's perception and description of physical pain, as well as affect the degree of functional disorder, loss of labor capacity, and treatment effect.

　　Low back pain more often refers to a symptom. When considering complications, the etiology should be taken into account. Since there are many causes of low back pain, the possible complications are also diverse, and the most common are chronic ligament or muscle injuries. If the old disease does not heal, it can also lead to intervertebral disc diseases and spinal stenosis, such as intervertebral disc bulging, protrusion, and intervertebral disc slippage, etc.

　　The causes of low back pain are diverse, and the clinical features are different according to different situations. The following is an introduction to this:

　　1. Acute self-limiting low back pain patients have no previous chronic discomfort. The typical onset is often related to overexertion, sprains, trauma, or stress reactions, and a detailed medical history and experience are sufficient for diagnosis.

　　2. The differential diagnosis of chronic low back pain is difficult. It can start with a detailed determination of the onset of the condition, the characteristics of the pain, and precise localization. The pain may be localized (with tenderness at the site of the lesion, as in fibromyalgia), or diffuse, as in primary fibromyalgia. The pain can also be caused by deep tissue, such as low back pain from chronic lumbar osteoarthritis. It can also be radiative, as in sciatica, or referred, as in peritonitis, pyelonephritis, osteoporosis, compressive fracture, or osteomyelitis. Back movement limitation due to pain, muscle tension, and paraspinal muscle tenderness is a common feature of all diseases affecting the musculoskeletal and nervous systems (mechanical pain). Pain worsens at rest and is relieved by stretching or activity, which is a feature of fibromuscular origin, but visceral referred pain (non-mechanical pain) does not have this feature. Typical visceral referred pain does not worsen with activity or relieve with rest and is usually persistent and worsens at night. The Valsalva maneuver (straining, coughing, sneezing) increases pain, limited straight leg raise, loss of reflexes, and sensory changes are characteristics of involved spinal nerve roots and sciatic nerves.

　　3. Sciatica is characterized by pain radiating along the sciatic nerve, most commonly to the posterior aspect of the buttocks and lower limb, with or without lower back pain. The most common cause is a herniated disc or a spinal cord tumor compressing the surrounding nerve roots. It can also be caused by spondylolisthesis, tumor, or abnormal bone in the vertebral canal or intervertebral foramen (such as osteoarthritis, spondylitis). It can also be due to pressure on the nerve outside the spinal cord, pelvis, or buttocks. Rarer causes include toxic or metabolic conditions (such as alcoholism, diabetic neuropathy). Such lesions can be confirmed by clinical or electrodiagnostic findings due to sensory or motor disturbances.

　　4. Spinal stenosis is an uncommon form of sciatica, caused by the narrowing of the lumbar vertebral canal, compressing the nerve roots before they exit the intervertebral foramen (or compressing the spinal cord, but less common), and is suspected of being a vascular disease due to similar intermittent claudication. Spinal stenosis is more common in middle-aged or elderly people and can be caused by osteoarthritis, Paget's disease, spondylolisthesis, or马尾水肿, and is characterized by pain in the buttocks, thigh, or lower leg during walking, running, or climbing stairs. Standing still does not relieve the pain, but bending over and sitting can. It is easier to walk uphill than downhill because the bending posture, rest, and back flexion can alleviate the pain to some extent.

　　5. Patients with physiological or psychological disorders often have a history of minor trauma, which causes disproportionate severe pain after injury, leading to the loss of activity ability, but no injury or primary disease can be found. In addition, anxiety and depression are usually present, but these persistent symptoms cannot be fully explained by lower back pain. Carefully obtaining the patient's description of pain and findings from examination is often non-specific, or inconsistent with any known neural anatomical pathways or disease processes. After excluding injuries or organic diseases, symptoms and functional disorders may continue to exist or even worsen, and many such manifestations may progress to more typical fibromyalgia.

　　The most important thing for the prevention of lower back pain is to find out the cause. Treat and care for the patient according to the cause, such as weight loss for overweight patients, improving muscle tension and strength, and improving posture. For patients with intervertebral joint arthritis, the use of special back braces and strengthening abdominal muscle exercises has a good therapeutic effect, and lumbar sacral flexion exercises can also improve muscle tension symptoms and prevent recurrence, etc.

　　Since the causes of lower back pain are diverse, clinical diagnosis of the disease also requires many auxiliary examination methods, such as X-ray examination, CT scan, bone scan, MRI examination. Especially, MRI examination can provide valuable images of longitudinal cavity deformation, providing stronger evidence for diagnosis. In addition, erythrocyte sedimentation rate and electromyography are also very necessary for specific differential diagnosis, and clinical diagnosis methods should be selected according to clinical manifestations.

　　Patients with lower back pain should have a light diet and pay attention to a reasonable diet. Common food therapy formulas include Ba Ji Du Zhong Pork Spine Soup. The raw materials are Ba Ji Tian four ounces, Du Zhong six ounces, Ji Qizi five ounces, Shan Yao five ounces, and one catty of pork spine. First, cut the pork spine into pieces, wash it, and blanch it in boiling water to remove the blood. Add the washed herbs and a sufficient amount of water, bring to a boil over high heat, and then simmer over low heat for 2 to 3 hours. Finally, add appropriate seasoning and it is ready to eat.

　　Patients with lower back pain can be treated with traditional Chinese medicine massage. Traditional Chinese medicine massage can adjust the body's Qi and blood, dredge Qi and blood, activate blood circulation and remove blood stasis, relieve swelling and pain, and can also relieve local muscle spasms, promote local blood and lymph circulation, and improve the blood supply to the skin and muscles.