Sacroiliac joint strain is one of the main causes of low back pain, often with acute attacks, and those with severe symptoms are unable to get out of bed, or even too bedridden to move slightly. It also turns into a chronic disease for a long time. The causes are mostly related to acute sprains or prolonged labor in unfavorable positions. In the past, posterior lumbar disc protrusion was mistaken for sacroiliac joint strain or dislocation, and was fixed with a belt. The two diseases were no longer confused after posterior lumbar disc herniation was confirmed in 1934. The sacroiliac joint is a micromotor olecranon joint, a synovial joint. This joint can rotate the iliac bone slightly forward due to the pull of the rectus abdominis muscle, while the pull of the posterior abdominal extensor muscle can rotate the iliac bone backward; if external force is applied to the lower part of the sacrum, such as a sudden fall and landing on the buttocks, it can rotate the sacrum forward; if external force is applied to the upper part of the sacrum, it can rotate the sacrum backward. Jumping can make the external force transmitted to the iliac bone through the lower limbs and make it move upward. Therefore, when the sacroiliac joint is overly passive, it can cause misalignment or subluxation of one or both sacroiliac joints. The joint surface of the two bones is already uneven, and after dislocation, the joint position is even more dislocated and interlocking occurs, while part of the ligaments are strained and strained and pain occurs, and sometimes reflex sciatica can be caused. Clinical diagnosis】 1. History: History of violent trauma. Or chronic joint strain caused by joint instability, repeated external force. 2, clinical symptoms: localized pain in the sacroiliac joint, the pain can be transmitted to the lateral aspect of the femoral trochanter and the front of the thigh and sometimes even radiates to the lateral aspect of the calf, and there is usually spasm of the affected vertical crest muscle. When standing, patients often support their weight on the healthy lower limb, and the affected lower limb is loosely flexed to reduce the N cord muscle pull. 3.Signs: The patient’s crestal lumbar segment may have lateral curvature and convexity toward the healthy side, and the lumbar muscle is tense. There is extensive pressure pain around the sacroiliac joint on the affected side, obvious pressure pain on the posterior upper and lower iliac spine, and percussion pain in the sacroiliac region. 4.Special examination: ① Sacroiliac joint separation test, also known as “4” test. The patient is in supine position, the operator puts the patient’s upper limb on the opposite knee after bending the knee as a disk, then one hand holds the opposite iliac crest, and the other hand presses the affected knee to the outside. If pain occurs in the sacroiliac joint, it is positive. ②Pelvic extrusion and separation test, the patient lies on his back, the operator puts both hands on the anterior superior iliac spine on both sides of the patient, separates the pelvis outward or squeezes it inward, and it is positive if it causes pain in the sacroiliac joint. ③ Prone leg lift test (Yeoman’s sign), the patient lies prone, the operator’s two hands press the sacral area, the assistant holds the affected side of the ankle to lift up, so that the hip joint is posteriorly extended, causing sacroiliac joint pain is positive. 5.X-ray examination: Acute sacroiliac joint disorder X-ray often has no abnormal performance. Chronic sprain or strain can have osteoarthritic changes and increased bone density at the edge of the joint. Differential diagnosis】 1. Lumbar disc herniation Lumbar disc herniation is accompanied by numbness and swelling pain in one lower limb, muscle tension on both sides of the crest, obvious pressure pain next to the vertebrae and radiating pain to the affected limb. If the sacroiliac joint is more seriously injured or has misalignment, the local pain is more intense and may radiate to the lateral femur, local muscle spasm, and the lumbosacral region has lateral flexion and forward flexion deformity, which may be misdiagnosed as lumbar disc herniation. 2.Sacroiliac joint tuberculosis No history of trauma, or only a history of minor trauma. There are systemic symptoms, such as hypothermia, night sweats, emaciation, etc. X-rays show that there is bone destruction. Basic treatment】 I. Manipulative treatment Manual repositioning is an effective method to treat the first iliac joint disorder, which can often receive good results. Local massage and relaxation should be carried out before applying manipulation. 1.Side lying single hip hyperextension repositioning method The patient is lying on his side, the healthy limb is under the natural extension, the affected limb is in the upper knee flexion, the operator stands on the affected dorsal side, holding the patient’s ankle with one hand, the other hand palm heel pushing the affected side of the posterior superior iliac spine. First, the affected limb is hyperextended in a small way, and when the patient is not prepared, the operator pulls the hand of the ankle with force to make the affected limb hyperextend, and the hand pushing the posterior superior iliac spine is used in the opposite direction at the same time, so that the joint can be heard to reset or the joint can be reset under the hand. 2.Shake reset method The patient is lying prone and grasps the head of the bed with both hands. The operator stands on the bed, holds the patient’s two ankles with each hand, and gradually pulls the patient’s body downward. At the same time of traction, raise the lower limbs so that the patient’s abdomen leaves the bed surface a little, and then swing the lower limbs from side to side several times. In the process of swinging the lower limb, shake it up and down several times to reset it. Second, local injection treatment Our department has used local injection of prednisolone acetate or tretinoin injection and local anesthetic injection methods for many years to achieve rapid relief or cure in treated cases. Often 1 time cure, supplemented by rest, the residual symptoms of the more serious can be 1 week after another injection. Injection method: the patient is in prone position, the affected sacroiliac area is disinfected, 5ml of 0.75% bupivacaine is extracted with a 10ml syringe, and then 2ml of prednisolone acetate or 1ml of tretinoin injection is extracted, and the treatment is given as an accurate limited small area injection at the most obvious pressure pain of the supra-sacroiliac ligament and sacrospinal muscle attachment. Within minutes after injection, the patient feels the pain completely disappears. The patient can be allowed to walk on the ground to check the effect and corroborate the diagnosis. Other therapies 1.Physical therapy such as hot compress, ultrashort wave and spectrum can be applied to relax the muscles, subside the edema and improve local blood circulation. 2. Acupuncture and moxibustion: Acupuncture points: Kidney Yu, Huanjiao, Zhizhong, Yinmen, Yanglingquan, and Aye points. Use diarrhea method, once a day, 10 times for a course of treatment. 3.Chinese medicine iontophoresis therapy: use Chinese medicine that relaxes tendons and blood, reduces swelling and pain, and carries out iontophoresis therapy. When the pain is obvious, oral anti-inflammatory and pain-relieving drugs such as fenbid and intracellular can be taken. (2) Chinese medicine classification and prescription 1.Qi stagnation and ligament obstruction type: pain in sacroiliac region is sometimes light and sometimes heavy, pain is indefinite, in severe cases, lumbar activity is restricted, walking is difficult, coughing and shaking pain, thin tongue coating, string pulse. The treatment is to regulate qi, open the ligaments, harmonize the camp and relieve pain. The formula uses Ze Lan Tang with Qiang Wu, Boswellia and Myrrh. 2.Blood stasis and qi obstruction type: pain in sacroiliac region limited to one side, localized ecchymosis, obvious pressure pain, and restricted lumbar movement. There may be abdominal distension, constipation, slight stasis on the tongue and tight pulse. Treatment is to move Qi, eliminate stasis, activate blood circulation and relieve pain. The formula is based on Dilong San, Fuyuan Wuhe Tang, Dacheng Tang, etc. 3. Chinese patent medicine: can be used such as doudu pills, Yunnan Baiyao, Sanqi tablets, wound seven flavor tablets, etc. For local swelling and pain, use Shuangbai San to wash the area, and apply swelling and pain relief cream and blood circulation pain relief cream externally, or use dog skin cream, Yunnan Baiyao paste, Qizheng Yan pain post and wound damp pain relief cream externally. The sacroiliac joint is the main part of the three joints in the pelvic ring, and is the hub of the connection between the crest and the lower limbs, and is the buffer belt of strength. Lower extremity parts such as hip, knee and ankle joint lesions can cause biomechanical changes that lead to pelvic tilt, resulting in sacroiliac joint injury and pelvic rotation. The functional exercise after the manual rehabilitation is also important to consolidate the effect and prevent recurrence. Usually focus on jogging, pay attention to the functional exercise of the lumbar and back muscles, and participate in ball games. Secondly, do a good job to prevent cold and keep warm. When sleeping, try to avoid cold wind blowing directly, so as to avoid lumbar muscle spasm caused by cold in the lumbosacral region. People who work sedentary, do not forget the lumbar health care, to often get up and move the waist, to prevent chronic strain injury of the lumbosacral muscle. Third, the appropriate amount of calcium and vitamins. Adequate calcium and vitamins can promote blood circulation throughout the body, which is conducive to the discharge of metabolic wastes in the body, and should usually consume more milk and soy products and fresh vegetables.