Outline:  
Lumbar sprain and contusion refers to acute injuries of lumbar muscle, fascia, ligament, small intervertebral joint and lumbosacral joint. Lumbar sprain mostly occurs when the lumbar muscle vigorously contracts or the lumbovertebral joint is greatly tracted or twisted. It may be caused by abnormal posture, over exertion in bending the waist to lift a heavy object, or sudden sprain at the moment bending waist and turning about, resulting in injuries of lumbar muscle, ligament and fascia, or transposition of small postolumbovertebral joint and sometime synovial incarceration. Lumbar contusion is usually caused by stroke of direct violence which leads to contusion of lumbar muscle and other tissues, and injury of blood vessels resulting in blood stasis, swelling and pain, or even complication of kidney injury.


Major points for diagnosis  
1. There is a definite traumatic history of the waist
 
2. After the injury, the patient has a sharp pain in tie waist with difficulty in stretching out, bowing and turning about. He is often in a posture with his arms akimbo t, prevent sharp pain caused by movement. In the severe cases, the patients can not sit, stand and walk. Some tines he has a referred pain. The pain may be aggravated by deep respiration, cough, sneezing or exertion in bowel movement. The spine is mostly in a rigid posture.
 
3. When the lumbar muscle and fascia are injured, there will occur limitation of lumbar movements in every direction, sharp pain and tension of the lumbar muscle induced by movement, tenderness in the sacrospinal musce, transverse process portion of lumbar spine or posterior part of sacro-iliac articulation. When the injury occurs in the supraspinal or interspinal ligaments, the tenderness is often in supraspinal or interspinal portion and the painis aggravated by bending of the spine.

When the injury occurs in the lumbosacral or sacro-iliac articulation, the tenderness is often in the lambosacral or sacro-iliac articulation portion, and the pain is aggravated by flexion and rotation of the spine. When there is synovial incarceration of small postolumbovertebral joint, the passive rotation of he waist will be restricted, especially obvious in backward extension that can cause deterioration of pain; the spire may bend laterally, some spinal processes may deviate and the tenderness occurs in the deep parts of both sides of the spinal processes.

4. If it is complicated by injury of the kidney, there may appear symptoms like hematuria.

5. X-ray film can show the disappearance of physiological lumbovertebral curvature or scoliosis. X-ray film should be carefully investigated to rule out fracture.


Treatment  
The effect of manual treatment for lumbar sprain is very remarkable. But herbal and acupuncture treatments are also needed in combination with it. The patient with lumbar contusion should be treated mainly with medication.
 
The patient lies in a prone position:
The operator gently kneads and presses with his two bands the two sides of the patient's spine from the back to the lumbosacral portion, beginning from the upper and moving down to the lower, for 3 to 5 minutes for relaxing tension and spasm of lumbar muscle. Then he presses and kneads the acupoints Ashi, Yaoyangguan (GV3), Mingmen (GV4), Shenshu (BL23), Dacbangshu (BL25) and Ciliao (BL32) for tranquilizing and alleviating pain. Finally, the operator presses the painful points in the waist with his left band and holds up the thigh of the sick side while making an effort to counter-pulling combined with shaking for several times. For the case of pain in both sides of the waist, the two thighs should be simultaneously pulled backward. For an acute case of serious symptoms, the manipulation should be done once a day, and for a mild case, every other day.
 
For the case of transposition or synovial incarceration of small postolumbovertebral joint, the reduction through rotating the spine in sitting position should be used. The patient sits erectly on a square bench with feet shoulder-width apart. Take the pain in the right side as an example, an assistant faces the patient, presses from both sides of the patient's left thigh with two legs and presses down on the root part of the thigh with two hands to keep the patient in the erect sitting posture.

The operator sits or stands by the posterior and right side of the patient. Passing the patient's right axilla, he puts his right hand forward and whirls around the back of the neck, then holds with fingers apart on both sides of the normal shoulder and neck portion. Then he pushes and presses with his left thumb the posteroinferior corner of the right deviated spinal process, makes with his right arm the patient's trunk bend forward to an angle of 600 to 900 and then turn to right to 450. While making the patient extend backward, the operator pushes and presses forcefully with his left thumb the spinal process leftward. At this time, under the finger a slight grinding action of the vertebrae can be felt or a small "Kala" (crack) sound can be heard. Finally, making the patient return to erect sitting position, the operator smoothes with his thumb and index finger the supraspinal ligaments and lumbar muscles from the upper to the lower.
 

Herbal therapy  
Internal treatment based on syndrome differentiation  
(1) Syndrome of blockage of stagnant blood
 
Main symptoms and signs:
Serious pain in the waist with the focus fixed, obvious swelling, difficulty in movement of the waist to all directions, or ecchymoses on the tongue, stringy or choppy pulse.

Therapeutic methods:
Promoting blood flow to remove the stasis, removing swelling to stop pain.
 
Recipe and herbs:
Modified Taohong Siwu Decoction. The herbs see the treatment of the same syndrome in neck sprain and contusion.
 
(2) Syndrome of blockage of qi flow
Main symptoms and signs:
Lumbago with no fixed focus, slight swelling, difficulty in movement at a certain direction, pink tongue, and stringy pulse.

Therapeutic method:
Promoting qi flow to alleviate pain.

Recipe and herbs:
Modified Liqi Zhitong Decoction.Specifically, Chaihu ( Radix Bupleuri )6 g, Danshen (Radix Salviae Miltiorrhizae )10 g, Oingpi (Pericarpium Citri Reticulatae Viride )6 g, Zhixiangfu (Rhizoma Cyperi Rotundi Praeparata)10 g, Chuanlianzi (Fructus Meliae Toosendan )10 g, Zhike ( Fructus Citri Aurantii)10 g, Ruxiang (Gummi Olibanum)10 g, Moyao (Myrrha)10 g, Yanhusuo (Rhizoma Corydalis)15 g, Lulutong (Fructus Liquidambaris )10 g and Gancao (Radix Glycyrrhizae )3 g.
 
(3) Syndrome of collateral disharmony
Main symptoms and signs:
Aching and dull pain in the waist, rigidity and weakness of the waist with impaired movement, pink tongue, and choppy pulse.

Therapeutic methods:
Relaxing tendons and activating collaterals.

Recipe and herbs:
Modified Huoxue Shujin Decoction. The herbs see the treatment of the same syndrome in external humeral epicondylitis.

External therapy:     
In the early stage, Xiaoyu Zhitong Paste or Sanse Application is externally used. In the late stage, fumigation and bathing of the sick part with Haitongpi Decoction is taken, or Tianhe Gutong Plaster or Zhenghonghua Oil is externally applied.

Fixation:       
For the serious case at the early stage of injury, the patient should take a rest on a hard plank bed for one or two weeks. For the mild case, a waistband may be used for fixation to alleviate pain, relieve spasm and prevent further injury.
 
Functional exercise:     
At the late stage of injury, the patient should be asked to practice exercises on various functions of the waist so as to promote circulation of qi and blood, prevent adhesion and enhance muscular power.
 
Acupuncture therapy:     
The frequently chosen points are Ashi, Shenshu (BL23), Mingmen (GV4), Zhishi (BL52), Dachangshu (BL25),Yaoyangguan (GV3), Weizhong (BL40) and Chenshan (BL57). Strong stimulation should be applied with the needle retained for 3 to 5 minutes. And cupping on painful points on the lumbar and sacral portions may be added.