Tuina treatment of supraspinal and interspinous ligament injuries

<h3 class=" id="p330" name="sigil_toc_id_66" > supractic and interspinous ligament injuries</h3>

Injuries to the supracous and interspinous ligaments are a symptom of acute and chronic injuries caused by sudden external force when bending over, or sudden loss of the psoas muscles while bearing weights, resulting in low back pain and dysfunction. According to statistics, supraspinal and interspinous ligament injuries account for 18% of patients with low back pain caused by soft tissue injuries, which is one of the common diseases leading to low back pain. The disease tends to occur in young, middle-aged manual workers, and is more common in men than in women. This disease belongs to the category of "tendon injuries" in Chinese medicine.

【Applied Anatomy】

1. Supraspinal ligament Supraspinal ligament is a cord-like fibrous tissue that is mounted on each vertebral spinous process, which is composed of an extension of the lumbar dorsal fascia, latissimus dorsi muscle, and fissure muscle. The supraspinal ligament is divided into three layers from top to bottom, deeply connecting the two adjacent spinous processes and intertwining with the interspinous ligaments; the middle layer spans 2 to 3 spinous processes; and the shallow layer spans 3 to 4 spinous processes. The supraspinal ligament begins in the 7th cervical spinous process, 73% ends in the 4th lumbar spinous process, and occasionally stops in the 3rd or 5th lumbar vertebrae, and the sacral spine does not have a supraspinal ligament. The supracous ligament is a cord-like collagen fiber tissue that is strong and sensitive, and has the effect of coordinating to stabilize the spine and limit excessive forward flexion of the spine. The supraspinal ligaments of the neck are wide and thick, called the necklace ligament, the supraspinal ligaments of the thoracic segment are thin and weak, and the supraspinal ligaments of the lumbar segment are relatively widened. The above anatomy determines that the supraspinous ligaments of the neck are less susceptible to injury, with injuries to the supracene acanthosis ligaments in the middle thoracic segment being the most common and supracene acanthosis ligaments in the lumbar segment less likely to be injured.

2. Interspinous ligament The interspinous ligament is located between two adjacent spinous processes, rectangular, its ventral side is connected to the yellow ligament, its dorsal side is fused with the fascia and suprapinous ligament of the dorsal long muscle, mainly composed of densely arranged collagen fibers and a small amount of elastic fibers, and its fiber arrangement is also divided into three layers, and the superficial fibers on both sides are obliquely backwards from the lower edge of the upper spinous process, attached to the upper edge of the next spinous process and the yellow ligament, and the middle fibers are arranged obliquely from the posterior upward obliquely downwards. Because its fibers are shorter, weaker and weaker, its tensile strength is weaker than that of the supracupracous ligament. When the lumbar spine is flexed forward, the interspinous ligament is stretched and stretched, and when the posterior extension is contracted, frequent stretching, compression and wear are easy to cause injury. Since there is no supraspinal ligament at the waist 5 to sacral 1, and the force is greatest between the active lumbar spine and the fixed sacrum, the chance of interspinous ligament injury is also greatest.

The supracous ligament and the interspinous ligament, innervated by the nerve endings of the posterior branch of the spinal nerve, are extremely sensitive tissues that, once injured, stimulate the passage through the posterior branch of the spinal nerve to the center, causing low back pain or referred lower extremity pain.

Schematic diagram of the joints and ligaments of the lumbar spine

【Etiology】

1. Acute injury Supraspinar and interspinous ligaments are protected by sacral spinous muscles under normal circumstances, and when the body is excessively flexed forward, sudden force can easily lead to interspinous ligament injury; in the case of sudden torsion, it is easy to cause supracous ligament injury. When bending down to carry heavy objects, the sacral spinosacral muscles are in a relatively relaxed state, the muscles of the hips and the back of the thighs are contracted, and the lumbar spine is used as a lever to lift the weight, and its fulcrum is in the lumbosacral region, and its load-bearing force falls on the ligaments, which is very easy to cause lacerations of the lumbar supracupracian ligaments. Or when bending over to work, a sudden external force strikes, forcing the waist to flex forward, causing tears in the supracupractic ligaments. Since the supraspinal ligament mostly terminates in the lumbar 3 and lumbar 4 spinous protrusions, and there is almost no supraspinal ligament below the waist 4, when bending over, its stress falls on the interspinous ligament, and when it is suddenly subjected to strong pulling or external force, it is easy to cause injury. Injuries manifest as ligament tears, bleeding, and exudation. Degenerative changes over time are more susceptible to damage.

2. Chronic strain Long-term engaged in stooped labor, its stress to maintain a stooped posture, mainly borne by the supraspinatus and interspinous ligaments. Because the ligament is often pulled and stretched beyond its elastic limits, edema, inflammation and adhesion gradually occur, stimulating the posterior branch of the lumbar spine nerve and causing chronic low back pain, or due to the degeneration of ligament fibers, the elasticity is weakened, at this time, such as bending down to bear weight, it is often prone to damage and strain of some fibers.

Chinese medicine believes that the disease is mostly caused by direct external force or indirect external force to cause acute damage to the tendons and veins of the back and waist, resulting in tendon damage, resulting in discord, meridian blockage, stagnation of qi and blood stasis, and pain. Over time, the qi and blood are deficient, and the tendons are lost, resulting in spasms, stiffness or tendon knots, and changes in the cords, and the pain is mostly tingling, and the pain is fixed. The Suqin Xuanming Five Qi has a record of "tendon wounds".

【Diagnosis】

(1) Injury to the supraspinal ligament

1. Symptoms

(1) It often occurs suddenly when stretching or twisting under bending down to bear weights, and the history of injury is short and rapid, but the force is not necessarily very large. Patients with chronic pain have a long history of working on desks and bending over and straining.

(2) In acute injuries, the midline of the spine is suddenly painful, often with fracture-like, needle-like or knife-like pain, and the patient feels tear-like when he feels injured.

(3) There is a lot of pain when bending down, and there is soreness in the deep back of the waist, and occasionally there is a vague pain involving the waist and legs.

(4) In patients with chronic strain, the supraspinal ligament is relaxed, the local pain is not obvious, but it cannot be bent over too long, and the waist cannot be straightened up immediately after bending, and the local soreness is swollen.

2. Signs

(1) Muscle tension Spasm of sacral spinous muscle and gluteus major muscle, and protective scoliosis of the spine.

(2) Tender points There is a more obvious tenderness at the apex of the spinous process or on both sides of it. The pain points often span more than 2 spinous processes, the tender site is superficial, and there are flaky or cord-like peels under the fingers, which can slide left and right.

(3) Dysfunction After injury, there is limited movement, the waist is straight, dare not bend forward, and the local pain is aggravated when the waist is bent forward.

3. Auxiliary examination X-ray examination can exclude fractures, and if there is a rupture of the supracous ligament, the spacing of the spinous process can be increased.

(2) Interspinous ligament injury

(1) Have a history of spinal torsional trauma. Often injured with supracous ligaments.

(2) The pain is located between the two spinous processes, which is deep in sexual pain and swelling pain, which is aggravated after exertion and relieved after rest.

(3) Heavy when bending over, light when stretching back, and passive twisting of the spine can make the pain worse.

(1) Muscle tension Spasm of the sacral spinous muscles can affect the inhalation and dare not take deep breaths.

(2) Tender points The tender points are limited to the adjacent two spinous processes, and the tenderness site is deep in the supraspinal ligament.

(3) Dysfunction The forward flexion function of the waist is obviously limited, and the degree of restriction is more obvious than the injury of the supracupracous ligament.

3. Auxiliary examination X-ray examination can exclude fractures, and if there is a rupture of the interspinous ligament, the spacing of the spinous process can be increased.

【Differential Diagnosis】

1. Acute psoas muscle sprain There is a history of obvious waist sprains, severe pain in the waist, limited movement in the waist, tension spasm of the sacral spinous muscles, and tender points in both sides of the waist.

2. Lumbar parietal joint disorder Most of the injury history is not obvious, there are spinous deviations, tender points are at the crooked spinous process, flexion and extension rotation is painful, coughing, sneezing pain is aggravated. X-ray may show spinous lateral deviation.

【Treatment】

1. Treatment principles Relax muscles and activate blood, reduce swelling and relieve pain, and straighten tendons and restore tendons.

2. Technique, pressing kneading method, pushing and erasing method, plucking method, rubbing method, etc.

3. Take the acupuncture point and the part A is the acupoint, the lumbar clip spinal point, the eight calvary, the Chengshan, the middle and the spinous process and gap of the affected part.

4. Operations

(1) The patient takes the prone position, and the doctor uses the operation on both sides of the ligament injury, up and down, and the technique should be deep and gentle, so that the patient can tolerate it. Then rub A is a point, waist clip spinal point and eight hips, Chengshan, Wei medium point, about 5 minutes, in order to relieve muscles and blood, relieve muscle spasm.

(2) Following the upward posture, the doctor operates with the kneading method on the local part of the ligament injury. For patients with supracous ligament injury, the treatment scope should be wider, and the technique should be gentle and gentle; in the case of interspinous ligament injury, the injury is mainly interspinous, and the technique should be slow and deep, and the strength of the disease should be reached to the degree that the patient can tolerate. Use light techniques to massage the treatment 3 to 5 times, and then do up and down the tendons along the direction of the supracupelas supraspinatus ligaments, for about 5 minutes to activate the blood and reduce swelling, relieve the tendons and relieve pain.

(3) Following the upward trend, the doctor uses the kneading method to focus on kneading nodular or cord-like substances to dissipate it. For those who have supracous ligament peeling, use the thumb flick method to reset the stripped ligament, and push up and down to apply the tendon, the technique should be gentle and gentle, the time is about 5 minutes, to relieve the pain, straighten the tendon.

(4) Following the upward trend, the doctor directly rubs the pulse and both sides of the bladder at the site of ligament injury, taking the heat permeability as the degree. Topical hot compresses can be combined with warm and humid to warm the meridians, activate blood and relieve pain.

【Precautions】

1. Grasp the key points of diagnosis, shallow tenderness above two spinous processes is supracous ligament injury; deep tenderness between two acanthous processes is interspinous ligament injury; tenderness at the apex of a single acanthous process is acanthous periosteum injury, and clinical attention should be paid to differentiation.

2. The acute injury technique should be gentle, mainly to relieve muscles and activate blood, reduce swelling and relieve pain, so as not to aggravate the injury; use the posterior extension method with caution to avoid squeezing and rubbing the supractic and interspinthal ligaments and aggravate the pain. During the remission period, the technique should be deep and gentle to promote injury recovery.

3. Local can be combined with wet hot compresses, and manual operations will no longer be performed after hot compresses to avoid skin lesions.

【Efficacy evaluation】

1. Heal the low back pain disappears, and the spinal activity function returns to normal.

2. Get better Waist pain is significantly reduced, and there is still pain when tired or bent over.

3. Unresolved Low back pain does not alleviate, and activity does not improve.