Sacroiliac joints are affected by external force and postural stress, causing damage to the ligaments around the pelvis or decrease in stability and misalignment, leading to the destruction of the pelvic weight-bearing mechanism, lumbosacral and lower limb pain and decrease in labor and living ability. I. Diagnostic basis: 1, women who have been born with chronic onset of the disease, may not have a history of lumbar trauma; young men with acute onset of the disease, with a history of lumbar trauma. 2, the performance of lumbosacral pain (a small number of patients can also appear coccygeal pain) and one or both sides of the lower limbs, the patient standing with the healthy limbs of the weight, sitting with the healthy side of the buttocks touching the chair; the severe cases can not even straighten the lower limbs when lying on their backs, like to flex the affected limbs lying on their backs or to the healthy side. The severe cases even cannot straighten the lower limbs when lying on their backs, preferring to bend the affected limbs to lie on their backs or to lie on their sides. 3, acute injury patients with pelvic tilt, scoliosis, “crooked hip limp” special posture, can not straighten the waist; due to the asymmetry of both sides of the hip bone, resulting in the three-dimensional position of the acetabulum to move upward or downward, the appearance of the two lower limbs are not equal; the two sides of the posterior iliac supraspinatus, iliac inferior spine and other bony markers asymmetric, and pressure pain and pain on percussion. Chronic strain patients due to spinal posture compensation, “crooked hip claudication” may not be obvious, but still can be found in the physical examination of the above signs. 4, orthopantomogram of the pelvis is the basic imaging basis for the diagnosis of this disease, mainly manifested as A staggered asymmetry of the width of the hip bone and the width of the closed foramen; B stepped changes on both sides of the pubic symphysis and asymmetry of the pubic bone diameter; C posterior iliac spine of the two sides is not at the same level, the posterior iliac spine of the person who has extended subluxation is on the upper side of the posterior iliac spine, and the posterior iliac spine of the person who has flexed subluxation is on the lower side of the posterior iliac spine; D chronic patients can be seen in the iliac side of the sacroiliac joint on the side of the affected side of the bone mineral density, previously known as dense iliopsoas. It was called dense iliitis in the past. 5. For those who are suspected of having synovitis of sacroiliac joints, axial films of sacroiliac joints can be taken; for those who are suspected of having localized manifestations of ankylosing spondylitis in sacroiliac joints, HLA-B27 can be used for further differentiation. Semi-dislocation of sacroiliac joint: sudden onset of disease, history of trauma before the onset of the disease, severe pain, change of position or coughing, sneezing pain intensification, the affected side of the lower limb was in a semi-flexion, active or passive extension and flexion are obviously limited and severe pain, lumbosacral percussion pain; the affected side of the “4” test, the bedside test, the pelvic extrusion test Positive. According to the direction of sacroiliac joint movement during subluxation, it can be divided into flexion subluxation and extension subluxation: A flexion subluxation of sacroiliac joint: the posterior superior iliac spine of the affected side is shifted downward, convex, and pseudo shortening of the lower limb; B extension subluxation of sacroiliac joint: the posterior superior iliac spine of the affected side is shifted upward, concave, and pseudo lengthening of the lower limb. Sacroiliac joint ligament sprain: sudden onset of disease, history of trauma before the onset of disease, moderate pain, pain worsens when position is changed, no percussion pain in lumbosacral region; the affected side is positive in “4” test, bedside test and pelvic compression test, but the bony structures of both sides of the pelvis are symmetrical, and there is pressure pain in the attachment of sacroiliac ligament such as second sacral middle spine, iliac crest, etc. The affected side is positive in “4” test, bedside test, and pelvic squeeze test, but the bony structures of both sides are symmetrical. Sacroiliac joint strain: chronic or insidious onset of the disease, the patient is conscious of the lower back, buttock pain and fatigue, but the distal symptoms of the lower limbs are not obvious, which is characterized by aching, numbness, distension, and fear of cold, etc.; some patients show intractable pain and tenderness in the sacrococcygeal area, and the sacroiliac joint drawer test is positive; the pelvic X-ray film shows the sign of the so-called “dense iliopsoas inflammation”. Pelvic X-ray shows the so-called “dense iliitis” sign. Chinese medicine typing 1, bone wrong tendon knot, stagnation of qi and blood stasis: history of trauma, severe pain, restlessness, dyskinesia, refusal to press on the injured area, localized swelling, dark tongue or petechiae, stringy pulse. Deficiency of the liver and kidney, tendon relaxation and bone fault: soreness and weakness of the waist and knees, fear of coldness and weakness of the lower limbs, intolerance to long walking and sitting, pain in the place of pain, pain aggravated after exertion, urination closed and not solid, frequent. The tongue is pale and the pulse is thin. Fourth, the treatment program orthopedic reset, restore the pelvic bearing function, rectification of the main maneuver. 1.Sacroiliac joint flexion subluxation: modified oblique trigger method (posterior superior iliac spine) or short lever micro-adjustment maneuver (lower end of sacrum, posterior superior iliac spine) is suitable for restoration. Sacroiliac joint extension subluxation: Modified oblique trigger method (sciatic tuberosity) or short lever fine-tuning maneuver (upper end of sacrum, sciatic tuberosity) is suitable for rehabilitation. Successful rehabilitation is marked by significant pain relief and restoration of symmetry of the pelvic bony structures. The lumbar activity returns to normal, clinical signs disappear, and the weight-bearing function of the affected limbs is restored. 3.Sacroiliac joint ligament sprain: stretch the sprained sacroiliac ligament and iliolumbar ligament by modified oblique trigger method (posterior superior iliac spine) and sacroiliac joint pulling and stretching method, and then operate locally in the damaged ligament by rubbing method, and the degree of heat permeability. The sign of effective manual therapy is the disappearance of lumbosacral pressure pain and the relief of lumbosacral motion pain. Sacroiliac joint strain: use short lever fine-tuning technique (lower end of sacrum, upper back of iliac spine) and short lever fine-tuning technique (upper end of sacrum, sciatica) to restore the sacroiliac joints, and then use sacroiliac joint pulling and stretching to make the joints close together, and then use friction method to manipulate the joints locally, and the degree of heat permeation is taken as the degree of effectiveness. The sign of effective manual therapy is the disappearance of lumbosacral pressure and pain, the relief of lumbosacral motion pain, and the restoration of weight-bearing function of the affected limbs. 5, bone wrong tendon knot, gas stagnation and blood stasis evidence: massage treatment is appropriate to activate blood circulation and eliminate blood stasis, swelling and pain relief ointment such as bone oil and so on external coating, to promote healing. 6. Deficiency of liver and kidney, tendon relaxation and bone wrong evidence: in the manipulative treatment at the same time can be combined with the guide exercise, outside the strong tendons and bones, internal solid liver and kidney. 7.Other therapiesA.Acupuncture and moxibustion: acupuncture points: Ah Yes point, kidney Yu, large intestine Yu, second s, lower Jiao Yu, ring jump, Yinmen, commission in the middle and other points. B. Wet and hot compresses of traditional Chinese medicine: suitable for patients with sacroiliac joint ligament sprains and sacroiliac joint strain. C. Guiding: knee flexion and hip flexion stirrup gong, snake walking gong, applicable to patients with sacroiliac joint strain injury. Complications 1, lumbar degeneration: sacroiliac joint strain patients due to spinal dynamic and static force balance imbalance, often combined with serious lumbar degeneration such as lumbar disc herniation, lumbar spondylolisthesis and other diseases, should be in the treatment of sacroiliac joint disease at the same time active treatment of lumbar spine disease. 2.Urinary tract syndrome: middle-aged and old women with sacroiliac joint strain injury are often affected by the pelvic parasympathetic nerves and complicate urethral syndrome, can be used in the treatment of sacroiliac joint problems at the same time vibration of the lower abdomen, rubbing the eights, and other operations to lift the parasympathetic nerves of the state of disruption, to restore the normal function of urination. 3.Sacral joint osteoarthritis: sacroiliac joint strain patients can be due to long-term joint mechanics imbalance, the local articular cartilage is too high concentration load and cause synovitis or osteoarthritis, even if the sacroiliac joint surface to restore the normal space joints, will still be in the lower limbs when weight bearing pain. It can be combined with local Chinese medicine hot compress and physiotherapy at the same time of manipulation treatment; for synovitis, sacroiliac joint closure can be used. Precautions: 1. Avoid walking continuously for several days after sacroiliac joint manipulation, especially walking up and down the stairs, so as not to aggravate the load of sacroiliac joint and cause re-dislocation. 2. 2. The ligaments and muscles around the sacroiliac joints are very developed, so there is a lot of resistance to manipulation, so the manipulation should not be rough, so as not to cause medical injury. Those who have difficulty in manipulation should be referred to a doctor or a higher level doctor for treatment. Assessment of therapeutic effect 1. Cure: clinical symptoms and signs disappear, and there is no obstacle in the activities of waist and lower limbs. 2.Improvement: clinical symptoms improve, signs reduce, waist and lower limb activities without obstacles. Ineffective: clinical symptoms and signs are reduced or unchanged, and the activities of waist and lower limbs are still impaired.