Recently, I have had many patients and friends ask me online about low back pain caused by inflammation of small joints. Comparison of symptoms. Symptomatically, most of these patients present with chronic low back pain, which is obvious in the morning and relieved after activity. On examination, there are pressure points next to the diseased lumbar spine, but on imaging examinations, such as CT and MRI, there are often no obvious lesions at the nerve roots, but there are inflammatory changes at the small joints of the lumbar spine. Patients with herniated discs also present with low back pain, but the biggest difference is that it is not obvious in the morning and gradually worsens with increased activity. Imaging examinations show herniated or bulging discs, nerve root compression, etc. What is the small joint? In the human lumbar spine, its posterior joint consists of the inferior articular processes of the superior vertebrae and the superior articular processes of the inferior vertebrae. The small joint surface is covered with cartilage and has a small joint cavity surrounded by the joint capsule, and its inner layer is the synovial membrane, which secretes synovial fluid to facilitate joint movement. The arrangement of the articular surface of the lumbar synapses is semi-frontal and semi-sagittal, and its cross-section is nearly arc-shaped, which is more flexible for extension, flexion, lateral flexion and rotation. Causes of Pain Differences Low back pain caused by inflammation of small joints may produce chronic sterile inflammation of small joints due to strain and sprain, resulting in pain. In the early morning, the relationship between the small joints is disturbed due to the sleep position, so the pain is aggravated, and after activity, the relative position between the joints is restored, and thus the pain is reduced. Low back pain caused by a herniated disc is mainly caused by the stimulation of the nerve roots by the herniated disc. In the early morning, the pain is lighter or disappears because the force on the lumbar disc decreases when lying down and the nerve roots are not stimulated, but after activity, the disc is compressed by gravity and protrudes significantly, stimulating the nerve roots, so the pain increases. This is the most common way that our doctors identify these two types of pain. Treatment Pain physicians have solutions for both types of low back pain. Patients with lumbar disc herniation can have a paravertebral block, or a lateral gap block in the spinal canal; patients with small joint inflammation can have a small joint block in the lumbar spine. Combined with triple oxygen (O3) injection treatment, the results are both very precise.