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LUMBALGIA

DENİZ ERDEM

DEFINITION

Low back pain is a common musculoskeletal symptom that may be either acute or chronic. It may be caused by a variety of diseases and disorders that affect the lumbar spine. Low back pain is often accompanied by sciatica, which is pain that involves the sciatic nerve and is felt in the lower back, the buttocks, and the backs of the thighs.

Low back pain varies in intensity, frequency, duration, and quality depending on the cause and stage of injury or illness as well as the time of day and activity level. It is considered either acute (of recent origin) or chronic(longer term) in nature, though these give little insight as to a particular cause of the pain. The degree of pain ranges from a mild annoyance that comes and goes to constant and totally disabling

CAUSES AND SYMPTOMS :

ACUTE PAIN
Acute pain in the lower back that does not extend to the leg is most commonly caused by a sprain or muscle tear, usually occurring within 24 hours of heavy lifting or overuse of the back muscles. The pain is usually localized, and there may be muscle spasms or soreness when the doctor touches the area. The patient usually feels better when resting.

CHRONIC PAIN
Chronic low back pain has several different possible causes: Mechanıcal Malıgnancy

Chronic strain on the muscles of the lower back may be caused by obesity; pregnancy; or job-related stooping, bending, or other stressful postures.
Low back pain at night that is not relieved by lying down may be caused by a tumor in the cauda equina (the roots of the spinal nerves controlling sensation in and movement of the legs), or a cancer that has spread to the spine from the prostate, breasts, or lungs. The risk factors for the spread of cancer to the lower back include a history of smoking, sudden weight loss, and age over 50.

ANKYLOSING SPONDYLITIS

Ankylosing spondylitis is a form of arthritis that causes chronic pain in the lower back. The pain is made worse by sitting or lying down and improves when the patient gets up. It is most commonly seen in males between 16 and 35. Ankylosing spondylitis is often confused with mechanical back pain in its early stages.

HERNIATED SPINAL DISK

Disk herniation is a disorder in which a spinal disk begins to bulge outward between the vertebrae. Herniated or ruptured disks are a common cause of chronic low back pain in adults.

PSYCHOGENIC

Back pain that is out of proportion to a minor injury, or that is unusually prolonged, may be associated with a somatoform disorder or other psychiatric disturbance.

Low back pain with leg involvement low back pain that radiates down the leg usually indicates involvement of the sciatic nerve. The nerve can be pinched or irritated by herniated disks, tumors of the cauda equina, abscesses in the space between the spinal cord and its covering,spinal stenosis, and compression fractures. Some patients experience numbness or weakness of the legs as well as pain.

WHAT ARE THE SYMPTOMS?

Symptoms include:

• Pain in the back or legs • Stiffness and limited motion. The pain may be continuous or may occur only in certain positions. It may be aggravated by coughing, sneezing, bending, twisting, or straining during a bowel movement. The pain may occur in only one spot or may spread to other areas, most commonly down the buttocks and into the back of the thigh

A low back strain typically does not produce pain past the knee into the calf or foot. tingling or numbness in the calf or foot may indicate a herniated disk or pinched nerve. Be sure to see your health care provider if: • You have weakness in your leg, especially if you cannot lift your foot, because this may be a sign of nerve damage. • You have new bowel or bladder problems as well as back pain, which may be a sign of severe injury to your spinal cord. • You have pain that gets worse despite treatment

HOW IS IT DIAGNOSED?
Health care provider will review patient’s medical history and examine it. He or she may order x-rays. In certain situations a myelogram, CT scan, or MRI may be ordered.

HOW IS IT TREATED? The following are ways to treat low back pain: • Using a heating pad or hot water bottle. • Taking ibuprofen, aspirin, or other anti-inflammatory medications. Occasionally muscle relaxants or other pain medications may be • Having your back massaged by a trained person. • Wearing a belt or corset to support your back. • Talking with a counselor, if your back pain is related to tension caused by emotional problems. • Beginning a program of physical therapy, or exercising on your own. Begin a regular exercise program to gently stretch and strengthen your muscles as soon as you can. your health care provider or physical therapist can recommend exercises that will not only help you feel better but will strengthen your muscles and help avoid back trouble later.

When the pain subsides, ask your health care provider about starting an exercise program such as the following: • Exercise moderately every day, using stretching and warm-up exercises suggested by your provider or physical therapist. • Exercise vigorously for about 30 minutes two or three times a week by walking, swimming, using a stationary bicycle, or doing low-impact aerobics. Participating regularly in an exercise program will not only help your back, it will also help keep you healthier overall.

ACUPUNCTURE FOR LOW BACK PAIN

TREATMENT POINTS:
First needle the empirical points and move the patient's body to a position where the pain begins to appear. Manipulate the needle with reducing method for 1-2 minutes. If the patient responds well, repeat this process a few times then insert auxillary/local points and retain for 15-20 minutes.

EMPIRICAL POINTS:

GV 26 - If pain is only on the midline of the back and patient has flexion/extension difficulty SI 3 - If pain is on the posterior-midline and also lateral and/or patient has torso rotation difficulty YAOTONGXUE - If pain is on either side of the posterior midline, pain above UB 23 UB 40 - Acute back pain on the ub meridian, pain below UB 23 UB 37 - In lieu of UB 40 If there is pain and tenderness here and no congestion of blood vessels at UB 40 GV 8 - Stiff and/or rigid spine

COLD/WIND/DAMP: SIGNS & SYMPTOMS:

Pain began after exposure to pathogenc cold/wind/damp heavy sensation and pain in the lumbar region stiffness of the muscles with possible limitation of movement pain usually involves a larger area and also be in the buttocks and/or down the leg area may feel cold to the touch and/or to the patient pain is often weather related pain is not alleviated by bed rest

TREATMENT POINTS: GV 3 - Expels cold damp UB 23 - Expels damp, tonifies the kidney UB 52 - Chronic back pain above UB 23, direct needle towards pain UB 32 - Sacral pain UB 54 - Expels cold and damp

CLASSIC MASSAGE (SWEDISH MASSAGE)

During a classic or swedish massage, the affected areas of the back are massaged. The skin and muscles of the affected area are targeted. This type of massage uses long, continuous strokes. They include: Sliding, Kneading, Friction, and Vibration. Swedish massage has been proven beneficial to those suffering from joint stiffness. It also reduces pain and increases overall function.

THAI MASSAGE

In thai massage, the limbs are pulled and stretched. Thai massage originated in ındia and is based largely on the techniques of yoga. This type of massage combines the techniques of a traditional massage with positions that resemble yoga poses during the massage. Research suggests that the massage, in conjunction with stretching, can be very beneficial in reducing or eliminating lower back pain. Thai massage is great for muscle relaxation, flexibility, increasing mobility, strengthening joints, and aiding in the treatment of chronic joint problems.

ACUPRESSURE

Acupressure involves applying pressure to certain points on the body. This type of massage is a form of traditional chinese medicine, which was derived from acupuncture. During an acupressure massage, physical pressure is applied to traditional acupuncture points by means of using the hands, elbows, and other devices. Acupressure can help alleviate ailments including stress, tension, arthritis, and other aches and pains.

DEEP TISSUE MASSAGE

A deep tissue massage is used for treating chronic muscle pain. deep tissue massage also works with muscle tightness, posture issues, and repetitive strains. The deep layers of the muscles and connective tissues are targeted during a deep tissue massage. The muscles in the back are worked by a massage therapist and the client may experience some soreness and discomfort a day or two after having the massage.

SPORTS MASSAGE
A sports massage is an effective way of easing back pain or muscle strain caused by athletics or exercising. a sports massage can often help lessen the aches and pains of physical activity. Sports massage techniques promote relieving deep muscle strains and tightness. They also promote flexibility. While originally developed to help athletes prepare for competition, sports massages now emphasize prevention and injury healing. This type of massage stimulates circulation and lymph fluids; it also uses trigger points to break down knots in muscles and increase range of motion.