| disease | Chronic Simple Traumatic Lumbocrural Pain |
Chronic simple traumatic spine nature of disease. Low back and leg pain, except for cases resulting from acute traumatic lumbar back pain or sequelae of spine fractures, are mostly caused by abnormal posture, continuous bending, or excessive fatigue. This leads to chronic cumulative strain on the ligaments or bones of the lumbosacral or sacroiliac joints, resulting in chronic ligament rupture, wear, or edema. In severe cases, fatigue fractures of the articular processes may occur, leading to chronic low back and leg pain. Most of these patients have no obvious history of trauma but rather suffer from prolonged improper posture or overexertion, which keeps the back muscles and ligaments in a stretched state.
bubble_chart Pathogenesis
When the contraction of the lumbar and back muscles lasts too long, the local production and accumulation of lactic acid increase, inhibiting normal muscle metabolism and leading to fatigue or soreness in the lumbago region. If the lumbar muscles continue to contract, and the concentration of lactic acid rises to 0.3%, muscle contraction completely stops (compared to a lactic acid concentration of 0.015% during adequate rest). The tension required to maintain posture is then borne by the ligaments. If bending continues, the supraspinous, interspinous, and ligamenta flava, as well as the posterior longitudinal ligament, facet joints, and joint capsules, may remain in a prolonged state of tension, leading to strain and causing lumbago pain. Especially after the age of 30–40, when these ligaments exhibit varying degrees of degenerative sexually transmitted disease changes, they are more prone to causing back pain.
Flexion of the lumbar spine can increase pressure on the anterior part of the intervertebral disc, pushing the nucleus pulposus backward and increasing tension on the annulus fibrosus and posterior longitudinal ligament. This may even lead to rupture of the annulus fibrosus and herniation of the nucleus, causing lumbocrural pain.If the tension continues to increase, the facet joint capsules become tense, leading to joint wear and compression of the anterior edges of adjacent vertebral bodies, further exacerbating lumbocrural pain.
bubble_chart Clinical Manifestations
Most patients have no obvious history of trauma, only reporting spontaneous chronic lumbago and leg pain. The pain is not severe or persistent, allowing them to move freely and continue working, though not for extended periods. They often experience soreness and weakness in the lower back, making it difficult to sit or stand for long, frequently requiring changes in posture or supporting the hips to slightly alleviate the lumbago. Over time, back muscle spasms may develop, with the location of the pain being unclear—some patients cannot pinpoint the most painful area, only indicating general discomfort across the lower back. Localized pain is not prominent, though pressing or tapping may reveal more severe tenderness in certain spots. There may be spasms in the back extensor muscles and limited function. Spinal curvature and radiating neuralgia are mild. If radiating neuralgia in the lower limbs persists, it is often due to irritation or compression of the nerve trunk, suggesting possible rupture of the intervertebral disc's annulus fibrosus or fracture of the articular process.
When treating chronic low back and leg pain, the first step is to alleviate the patient's concerns and strengthen their confidence in recovery. Improve work and living environments, and correct poor working postures. Avoid excessive fatigue, then engage in appropriate functional exercises. Local physiotherapy or heat therapy can be applied. If necessary, muscle-relaxing, blood-activating analgesics may be administered, or tender areas may be blocked with injections, along with acupuncture and tuina. For stubborn cases, functional exercises can be combined with the use of a wide waist belt for protection, or if necessary, seasonal epidemic back muscle release surgery.
