Outline:  
Lumbar strain refers to the accumulated chronic injury of muscle, fascia, ligament, bone and joint in the waist. It is a commonly encountered disease resulting in chronic lumbago. A long term of exertion of the waist or bending over as well as a long-term unfavorable posture of the waist may cause strain of lumbar muscle, fascia and ligament or chronic laceration or blockage of stagnant blood, resulting in long-standing lumbago. If an acute lumbar sprain and contusion has not been treated timely and effectively, it may become a chronic lumbago.

When a constitutionally weak person with insufficiency of kidney qi is invaded by exogenous pathogenic wind, cold and dampness that block the tendons and meridians, it will lead to chronic lumbago. Such congenital lumbosacral deformities as sacralization of lumbus vertebrae, lumharization of sacral vertebrae, subfissure of sacral spine and free spinal processes may cause abnormality of starting and ending points of muscles or imbalance movement of the lumbus, hence resulting in strain.


Major points for diagnosis  
1. There is a history of acute lumbar injury or lumbar exertion.
 
2. The patient has lumbago, which is sometimes relieved and sometimes worsened, mostly of dull nature and repeated attack. The pain is alleviated by rest and aggravated by exertion. A moderate activity or a change of posture may alleviate it. The patient has difficulty in doing work bending the lumbus. If he bends his back over with an effort, the lumbago will get more serious. The patient likes pounding his waist with two hands. And the pain is usually related to climatic changes.
 
3. Generally the appearance of spine is normal and there is no trouble in flexion and extension. The tenderness spots are mostly on the sacral iliac muscles, posterior portion of iliac crest or ending point of lumbodorsal muscle posterior to the sacrum, sometimes at the spinal process or on the inter spinous portion. In the severe case of serious pain there is a slight limitation of activity. Nervous system examination is negative and raising test of the straightened leg is also negative.

4. X-ray film can reveal straightening of lumbar spine, scoliosis of hyperosteogeny of lumbar spine. In a few cases of congenital deformities, sacralization of lumbar vertebrae, lumbarization of sacral vertebrae and bifid spine may be found.


Treatment  
The principal aspect should be distinguished from the secondary aspect in treatment of lumbar strain, which is caused by many factors. The methods include two aspects of symptomatic treatment and etiological treatment.

Tendon-smoothing manipulation:        
It is more or less the same as the treatment for lumbar sprain and contusion, that is, manipulations of kneading, pressing, grasping, pinching, pulling thigh and pressing waist. The manipulation should be gently applied and the range of operation should be larger for the case caused mainly by pathogenic cold and dampness or the old patient with lumbago. For the case of weakness of lumbar muscle, rolling and kneading manipulations should be emphasized; and for the case of spasm of lumbar muscles, grasping, pinching, pushing and smoothing manipulations should be emphasized so as to relax tendons and promote blood flow, relieve spasm and pain. The manipulation should be performed once every other day, and 10 sessions will make up a course. During the period of treatment, the patient should take care not to get tired and catch cold.


Herbal therapy  
Internal treatment based on syndrome different iat ion
(1) Syndrome of qi and blood stagnation
   
Main symptoms and signs:
Serious fixed lumbago, slight swelling, obviously impaired movement, 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 syndrome of blockage of stagnant blood in injure of collateral ligament of knee joint.
 
(2) Syndrome of collateral disharmony
 
 Main symptoms and signs:
Aching and dull pain in the waist aggravated by exertion, rigidity and weakness of the waist with difficulty in movement, pink tongue and choppy pulse.
 
Therapeutic methods:
Relaxing tendons and activating collaterals.
 
Recipe and herbs:
Modified Huoxue Shujin Decoction. Specifically, Qianghuo (Rhizoma seu Radix Notopterygii) 6 g, Jingjie ( Herba Schizonepetae ) 6 g, Honghua (Flos Carthmi) 6 g, Zhike (Fructus Citri Aurantii) 6 g, Duhuo (Radix Angelicae Pubescentis) 9 g, Fangfeng (Radix Ledebouriellae Divaricatae) 9 g, Niuxi (Radix Achyranthis Bidentatae ) 9 g, Wujiapi ( Cortex Acanthopanacis ) 9 g, Duzhong ( Cortex Eucommiaeulmoidis ) 9 g, Danggui (Radix Angelicae Sinensis ) 9 g, Xuduan ( Radix Dipsaci ) 12 g, Qingpi ( Pericarpium Citri Reticulatae Viride ) 5 g and Gancao (Radix Glycyrrhizae ) 3 g.
 
 
External therapy:     
Shangke Xiaoyan Paste or Tianhe Gutong Plaster is topically applied, or Zhenghonghua Oil or Zhengu Liquor is externally applied.

Fixation:     
For the case of severe attack of pain, a waistband may be used for fixation for 3 to 5 days. A long term of bending over work should be ordinarily avoided.

Functional exercise:       
The patient should practice active functional exercise on lumbodorsal muscle. At the beginning, he may conduct the five-point, three-point and arch-bridge support exercises, then the flying swallow-like exercise, once or twice a day. The functional exercise should be done in an order, step by step and persistently. Ordinarily, if one is long working in a sitting posture, he should do exercise on lumbar flexion, extension and rotation for 3 to 5 minutes at intervals of about one hour.

Acupuncture therapy:       
The acupoints chosen are Ashi, Shenshu (BL23), Yaoyangguan (GV3), Mingmen (GV4), Zhishi (BL52), and Qihaishu (BL24). Moxibustion and cupping may be added after acupuncture to expel cold, warm meridians and relieve pain. Employ the therapy once a day, and 10 sessions make up a course. In ear acupuncture, the lumbosacral portion should be chosen. Twirling manipulation may be applied. Acupuncture is performed in both ears, the needles are retained for 10 minutes, once every other day, for consecutive 2or 3 sessions.