I. Definition.
Lumbar small joint disorder, also known as lumbar vertebral bone misalignment or small joint synovial impaction, is a common clinical condition, a frequent disease, and a common cause of acute low back pain. Mostly due to the uncoordinated movement of the lumbar region and cause subtle changes in the anatomical position of the small joints after the lumbar spine.
Anatomy of the disease.
Each lumbar vertebra has three joints, namely the 3-point system, two posterior joints and one intervertebral joint, and the posterior articular surface of the lumbar vertebra is in a sagittal position, and the posterior articular surface of the 5th lumbar vertebra is close to a coronal position. Each small joint is surrounded by the joint capsule and lined with synovial membrane, which has rich nerve endings and is extremely sensitive to stimulation or inflammation. The small joints of the lumbar spine are micro-movement joints, the lumbar rotational movement mainly by the two rear joints for movement, the small joints of the lumbar spine mainly to maintain the stability of the spine and play a certain range of guidance and restrictive role.
Etiology and pathology.
When the lumbar spine is flexed and extended, the joint capsule of the small joints also moves, and the joint capsule is tense when the lumbar spine is flexed forward and relaxed when it is extended backward. When the lumbar in the incorrect posture of the weight, sudden flash twist, so that the posterior joint of the spinal joint is pulled, and cause the joint position of the movement is not normal, the small joint space open, in the small joint cavity caused negative pressure, so that the synovial membrane into the joint space, and severe pain, and at the same time caused reflex spasm of the muscles of the lumbar back, so that the embedded object is subject to greater compression, resulting in continuous pain.
This disease can be divided into 3 categories: simple subluxation of the posterior joint, synovial subluxation, and posterior arthritis.
According to Chinese medicine, if the liver and kidney are deficient, the tendons and bones are not nourished, or if the fall and twist, then the machine is misaligned and cannot walk. It is recorded: “bruises, stasis and condensation, the body must be prone, if you want to lie down, can not be, pain is unbearable, lumbar tendon stiffness.” It is pointed out that this disease is mostly caused by traumatic factors.
IV. Clinical manifestations.
When the lumbar region is straightened after a forward bending or rotating movement (like brushing teeth), the pain in the lumbar region suddenly occurs, and the pain becomes restless, and the pain is obviously aggravated by a little activity, forcing the position, or even unable to go to bed, the pain is mostly limited to the lumbar region, and sometimes the pain can radiate to the lower limbs, and the pain is aggravated when coughing or sneezing.
V. Physical signs and examination.
1. Palpation: the lumbar muscles are tense and the pressure pain is obvious, the pressure pain point is usually between the 3rd lumbar vertebra and the 1st sacral vertebra, favoring the spinous process side, and the percussion pain is positive.
2.Lumbar movement is obviously restricted, and the lumbar region is in a particular passive position.
3.Posterior extension test of lower limbs is positive, and straight leg raise test is sometimes positive.
4.X-ray examination shows scoliosis and deviation of the spinous process.
Sixth, the diagnosis is based on.
1, the onset of acute, with a clear history of sudden lumbar sprain.
2, lumbar pain, limited movement. The lumbar region is in a rigid flexion position, and the posterior extension activity is obviously limited. Patients mostly take the posterior protrusion position, standing hip, knee joint often take a semi-bending position, two hands to support the knee.
3, the affected vertebrae paravertebral pressure pain, may appear affected spinal eminence distortion, hypertelorism, local muscle tension, pressure pain is obvious.
VII. Differential diagnosis
1, lumbar compression fracture with a clear history of trauma, the injured vertebral body spine pressure pain, percussion pain is obvious, mostly in the elderly, X-ray shows the flattening of the vertebral body.
2, lumbar muscle sprain There is a clear history of lumbar sprain, pain in the sacrospinous muscle or lumbar square muscle area, each vertebral body spine without pressure pain.
Eight, massage and rehabilitation treatment.
Commonly used techniques and steps are:
1, the patient takes a prone position, the doctor stands on his affected side. In the lumbar pain point next to the implementation of rolling method, so that the spastic muscles can be relaxed, time about 10 minutes.
2.Shake
3.Rolling at an angle
4, can also use sitting straight waist rotation tug method, sitting bending positioning rotation tug method, lumbar back extension tug method, back method, etc..
5.After the reset, press and knead along both sides of the lumbar vertebrae for several minutes to relieve pain.
Nine, postoperative precautions.
1, the acute period should be appropriate bed rest 1-2 weeks, after the symptoms are relieved, the work should be fixed with a lumbar girth or wide cloth belt.
2.Lay on the bed and carry out appropriate lumbar exercise.
3, lumbar activities should be gentle movements, local warmth.
Ten, treatment tips.
Manipulation treatment of lumbar posterior joint misalignment is the preferred clinical treatment method, but the diagnosis must be clear and the treatment must be based on evidence. On the clinical selection of which manipulation for treatment, mainly according to the patient’s condition. The treatment is carried out in a position that is easily accepted by the patient and with the appropriate technique, which can relieve the patient’s fear and make the muscles of the back easy to relax. The success rate of stitch manipulation is only as high as the relaxation. The rehabilitation should not be forced to sound, nor should it be forced to reset successfully at one time, so as not to aggravate the injury.