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Condition Treated / Pain Conditions

Black Pain (Acute lumbar Sprain)

Acute lumbar Sprain

Acute lumbar sprain refers to acute injury of lumbar muscles, fascia, ligaments, intervertebral
articular and lumbosacral joints when working or doing exercise. It is normally caused by
external force such as overloaded traction or wedge pressure. Acute lumbar sprain is a commonly
encountered and multiple clinic disorder. It is incidental to young adults and laborers as well as those who lack physical work or work with improper posture. It occurs more often among males
than females. If it is improperly treated or not treated in time, it may develop into a chronic disorder.

The causes of acute lumbar sprain are various, often related to overstrain, physical activity, health condition of the back and waist, tiredness and changes of weather or seasons. Most patients can clearly tell the position of their body when being injured and the location of the pain. The following factors are frequently responsible for acute lumbar sprain:

(1) improper posture of the waist (for instance, when the patient bends the waist to lift heavy objects, the center of gravity is shifted away from the central axis of the body and more pressure is put on the muscles due to lever effect, and consequently causing acute lumbar muscles sprain);

(2) tumbling over while walking on uneven road or tipping over while going downstairs, causing fascia sprain or laceration of fascia of lumbar muscles;

(3) imbalance of action while lifting objects that may shift the center of gravity, making the lumbar muscles contract violently and cause acute lumbar sprain;

(4) underestimation of a movement, such as pouring water, bending body, sudden standing up or even sneezing that may lead to acute lumbar sprain.

Acute lumbar sprain is clinically seen among acute injury of fascia of lumbar muscles, acute injury of lumbar ligaments and acute disorder of posterior lumbar joint.

Clinical manifestations

(1) Acute injury of fascia of lumbar muscles

Acute injury of fascia of lumbar muscles is a common lumbar injury. It is normally caused by lifting heavy objects with a sudden action or a stoop posture or sudden turning around with a stoop posture that may make the lumbar muscles and fascia contract and twist excessively or even lacerate. The degree of injury varies due to difference in exertion. The main symptoms are laceration of sacrospinal muscle from the starting point of sacrum or fascia laceration at the attachment point. Injury of fascia and vessels will inevitably cause stagnationof blood and obstruction of Qi, and eventually leading to swelling, pain and limited movement.

The clinical manifestations are feeling of tissue laceration, lumbar snap, lateral or bilateral
lumbar pain, inability to straighten, bend or extend the waist, aggravation of pain when turning
the body or sitting up, difficulty in moving the waist, stiffness of the waist, and aggravation
when getting up from the bed, exerting force, coughing or sneezing. If the case is mild, the
patient still can work but the symptoms will be worsened several hours later. In order to relieve
the pain, the patient normally holds his waist with both hands. The pain is normally in the
lumbosacral area, or in the lateral or bilateral side of the buttock and posterior side of the
thigh with uncertain location and nature. The usual symptoms are swelling, distention, purple
tongue with ecchymosis, thin fur, slow or wiry pulse.

Physical examination shows that, in the early stage, the pain may be caused by laceration of
muscles, fascia and ligaments that may lead to protective spasm and reduced physiological lordosis. Anisomerous muscle spasm may cause physiological scoliosis. These symptoms will be alleviated or disappear automatically after the pain is relived.

There is local tenderness in most cases in lumbosacral joint, the tip of the third lumbar transverse process and postlaminar part of iliac crest. The tenderness is the place where the injured soft tissue is located and is one of the parts to be examined. It is also a protective reaction caused by the pain due to injury of sacrospinalis and gluteus maximus.

For those with acute lumbar muscle sprain, the lumbosacral orthophoria and lateral X-ray examination should be taken. If necessary, oblique position X-ray examination should also be
taken. For those with usual soft tissue injury, X-ray examination will reveal any signs of
pathologic fracture of lumbar isthmus, hyperostosis, tumor or tuberculosis.

(2) Acute injury of lumbar ligaments

The main lumbar ligaments are: anterior longitudinal ligaments, posterior longitudinal ligaments, ligamenta flava, interspinal ligaments, supraspinal ligaments, intertransverse ligaments and vertebral articular capsules and vertebral ligaments. The commonly seen ligament injuries are the injuries of supraspinal ligaments, interspinal ligaments and iliolumbar ligaments. The lumbar ligaments are normally protected by sacrospinalis, but when one bends over to move objects, the sacrospinalis is in a loosen state, the muscles of buttocks and posterior muscles of the thighs will contract, leading to injury of supraspinal ligaments and interspinal ligaments, especially the ligaments in the lumbosacral area. Moreover, lumbar injury can directly injure the lumbar ligaments. Concurrent fracture, dislocation and nerve damage are often seen in this type of injury. Other symptoms are reddish purple tongue, whitish and thin tongue coating, wiry and tense pulse.

The injuries of supraspinal ligaments, interspinal ligaments often take place when one is working
with a bending posture. The patient usually hears a clear snap and feels lacerating pain in the
waist, and immediately followed by sudden local pain appearing like lacerating, stabbing or cutting
with the symptoms of local ecchymosis, swelling and difficulty to sit or lie down, often accompanied by radiating pain in the lower limbs, lumbar spasm, limited movement and aggravated pain when bending forward. There is evident tenderness in the injured spinous process or interspinal space. Local blocking therapy can relieve or eliminate the pain. The cases with
lacerated supraspinal ligaments, interspinal ligaments and widened interspinous distance can be
diagnosed by palpation. X-ray examination finds no abnormal changes in the injury of ligaments. For the cases of lacerated supraspinal ligament and interspinal ligaments, the interspinous space is usually widened.

(3) Acute synovial incarceration of posterior lumbar joint

It is also called disorder of posterior lumbar joints or lumbar intervertebral articular syndrome. Lumbar posterior joint is composed of inferior articular process of epistatic vertebra and superior articular process of hypostatic vertebra. There is a right angle between the two articular processes, one is coronal, the other is sagittal. That is why there is a wide angle of lateral curvature or
anteroposterior flexion and extension. Lumbosacral joint is a articular facet obliquely located
between the coronal and sagittal processes. Since the upright plane gradually becomes horizontal,
there are loose articular capsule and wide range of rotation, flexion and extension. When the
lumbar part suddenly bends forward or rotates without preparation, the joint posterior space of
lumbar vertebra stretches open, and then negative pressure takes place in the joint, sucking in the
synovial membrane. If the antistemum suddenly stretches backward, the synovial membrane will be stuck in the articular facets, causing posterior lumbar articular synovial incarceration, or the
cartilage displacement of the articular process facets, eventually resulting in severe pain in the
lumbar region. If there exists asymmetric congenital lumbosacral articular process and one side of
the joint moves obliquely, it may easily cause periosteum incarceration or displacement of
articular process.

The cause of this disorder was unclear before, so most of the cases were misdiagnosed as acute injury of lumbar muscular fascia or acute lumbar fibrositis, delaying proper treatment and often leading to chronic lumbago. It is now regarded as a common clinical disorder, one of the common causes that lead to acute lumbago. It is commonly seen among young people, especially in males. It is caused by mild acute lumbar sprain or sudden standing up when bending the waist, consequently twisting the articular process and causing synovial incarceration and limited movement of antistemum.

Clinically the patient may have a history of lumbar sprain or sudden standing up when bending the
waist. Usually severe pain appears right after injury of the waist, especially in movement. There
is stiffness in the waist, and the functional activity is lost. Lumbar examination shows stiff
flexed position, evident restricted back stretching movement without nerve root irritation sign.
Palpation will not find spinal deviation of the affected anti sternum. There is no sign of the
change of spinous process intervals. There is evident tenderness in L4-5 or L5-S I interspinal
spaces and para vertebral body. X-ray examination shows asymmetrical rank of posterior joints in
some cases, or posterior process and lateral curvature of lumbar vertebra and inequality in width
of intervertebral spaces. Other symptoms are purple tongue with ecchymosis, thin and yellowish fur, sunken and tense pulse.

Treatment

1. Therapeutic principles: Soothing tendons and activating blood.
2. Location of Acupoints: Shenshu (BL 23), Dachangshu (BL 25), Huantiao (GB 30), Yinmen (BL37), Weizhong (BL 40), Chengshan (BL 57), Yanglingquan (GB 34), Kunlun (BL 60), Ashi points and dorsolumbar areas.
3. Manipulations.

Pain Care Acupuncture Clinic is your local acupuncture office in Torrance, CA . specializing in treating injuries and chronic pain. Dr. Ming Chen and Dr. Lu Yang, Both acupuncturists who also the oriental medical doctor ( O.M.D. ) can pinpoint the cause of the injury and suggest the best treatment methods for you. You need our doctor to listen to the whole story and examine you, so that you can get started treating on your injuries or chronic pain and get you on the track toward recovery.

Call now for a free health consultation !

310-316-5707

Visit out Pain Care Acupuncture Clinic in;

21320 Howthorne Blvd., Suite 203 Torrance, CA 90503