Disease Overview Lumbar small joint disorder refers to a series of clinical syndromes caused by trauma, degenerative changes and congenital development that result in changes in the anatomical position of the small joints of the lumbar spine, leading to malfunction of the lumbar spine: this disease is mostly caused by reflex muscle spasm due to synovial imbrication of the small joints of the lumbar spine and tension of some ligaments and joint capsule, which causes the joints to be in an abnormal or twisted position. This disease belongs to the category of “misalignment” in Chinese medicine. Anatomy The vertebrae of the spine, except the atlas and the cardinal vertebrae, have upper and lower synapses of varying sizes and inclinations, and thus constitute synovial joints, which are synovial joints surrounded by a joint capsule and lined with synovial membrane. The joint surface of the synovial joints of the lumbar spine is sagittal, and the joint capsule is loose. When the lumbar region is flexed and extended, the synovial joints also move with it, and the pressure in the joint cavity changes with the movement. When suddenly turning or extending the waist upright, the joint space widens, generating negative pressure, which draws in the synovial membrane, and when the waist is quickly straightened, it is caught in it, causing acute severe pain in the waist due to synovial membrane stimulation. When the synovium is entrapped, it often causes synovial congestion, edema, joint effusion, synovial thickening, and swelling of the joint capsule, which stimulates the joint branch of the posterior medial branch of the lumbar nerve and produces pain, resulting in chronic phase manifestations. Epidemiology Mostly in the lumbar intervertebral joints and lumbosacral joints, the disease occurs in young adults, more in men than in women. Etiology Acute sprain or chronic strain of the lumbar spine is the main cause of this evidence, while degenerative changes of the spine in old age are common in the elderly. Due to chronic strain on the soft tissues of the lumbar supraspinous ligaments, multifidus, lumbar square, lumbaris major or sacrospinous muscles, the lumbar joints cannot withstand the normal external forces and act for a long period of time, causing secondary damage to the small joints, joint capsule and joint ligaments of the lumbar spine, which eventually leads to lumbar instability. When bending too long, or when there is an acute lumbar sprain, it causes lumbar spine small joint disorder, lumbar pain, limited activities and other symptoms. Disorders of the small joints of the lumbar spine, such as misalignment is large, will easily lead to damage to the surrounding soft tissues, resulting in Wujinxing inflammation, or edema of the surrounding soft tissues, narrowing of the intervertebral foramen, compression or stimulation of peripheral nerves, causing neuroinflammatory reaction, resulting in a series of complex syndromes, in addition to not muscle spasm caused by pain, along the nerve distribution area will appear the corresponding neurological reaction, if not treated in a timely manner will cause changes in the mechanics of the spine If left untreated, it can cause changes in spinal mechanics and become the main cause of lumbar disc herniation. Clinical manifestations It often develops during lumbar activities, with severe and unbearable pain in the lumbar region, so that it is impossible to bend upright, and even affects breathing and coughing, which can aggravate the lumbar pain and often leads to limitation of lumbar activities. On physical examination, it is seen that the spinal column is retroconvex or laterally convex, the lumbar muscles are spasmodic, especially the sacrospinous muscles, the pressure pain between the spinous process and the spinous process is obvious, the lumbar region may have percussion pain, the deep pressure pain in the lumbar region is obvious, the physiological curvature of the lumbar spine is changed on X-ray, and no other changes are seen. Clinical diagnosis, careful collection of medical history, careful physical examination, pay attention to differentiation from related diseases. There were no special adjuvant thrifty examination positive findings. Anatomical midpoint pressure pain point closure can be used as a therapeutic diagnosis. Auxiliary examination 1, X-ray lumbar spine X-ray film to exclude other diseases of the lumbar spine, lumbar small joint disorders can be seen in the lumbar spine posterior joint alignment direction asymmetry, lumbar scoliosis or posterior protrusion deformity, lumbar spine gap left and right asymmetry. 2, CT or MRI if suspected of lumbar disc herniation, CT or MRI examination is required for differentiation. Diagnosis and differential diagnosis (a) Diagnosis 1, the patient mostly has a history of acute lumbar sprain, lumbar sprain often recurrent, the same position can induce lumbar habitual sprain. 2. The main manifestations are pain in one or both sides of the lumbar region, stiffness of the lumbar muscles, restricted activities such as bending and back extension, and pain sometimes radiating to the buttocks along the lumbar vertebrae. 3.The lumbar percussion pain is obvious, and the deep pressure pain at the lesion site is obvious. 4.The misaligned segment of the spinous process has obvious pressure pain and percussion pain, and palpation can reveal the spinous process deviated to one side, the soft tissue next to the spinous process is swollen to varying degrees, and there is a cord-like sensation on palpation. 5. X-ray film shows unnatural physiological curvature of the lumbar region and no other obvious changes. (2) Differential diagnosis The disease is mainly characterized by lumbar pain and should be differentiated from the following diseases. 1, lumbar muscle strain lumbar muscle strain pressure point is often at the lumbar muscle belly, pressure pain with soreness and swelling, the symptoms improve after heat or rest. The symptoms of spinal tumor are progressively aggravated, especially at night. x-ray CT or MRI examination can find lumbar vertebral bone changes for differential diagnosis. The symptoms of lumbar disc herniation mostly occur in middle-aged and young people, often with low back pain with lower limb radiating pain, positive straight leg raising test, bed rest can reduce the symptoms, increased abdominal pressure can aggravate the symptoms, CT or MRI examination can find the nucleus pulposus protruding into the canal. 4.Pear-shaped muscle syndrome hip pain can be radiated to the whole lower limb, and the pressure pain in the hip radiates to the posterior femur, the posterior lateral calf and the sole of the foot, and there can be pressure pain along the sciatic nerve. Electromyography suggests prolonged latency, fibrillation potentials, and other signs of nerve damage. A stiffer or elevated pear-shaped muscle can be felt in the middle of the buttock in the prone position. Positive pear-shaped muscle tone test. 5, supraspinous and interspinous ligament injury lumbar pain in the middle of the spine, interspinous pressure pain, no muscle spasm on both sides of the lumbar region. Treatment (a) Chinese medicine treatment This disease belongs to the category of “lumbago” and “paralysis” in Chinese medicine. It is mostly caused by the feeling of external evil, or the destabilization of the spine after external force, and the inability of the meridians to pass through. In the early stage of treatment, we use blood circulation to remove blood stasis, move qi and relieve pain, and the formula is supplemented by He Ying Pain Relief Soup. (1) Qi stagnation and Luo obstruction: lumbar pain is sometimes mild and sometimes severe, pain is indefinite, in severe cases, lumbar movement is restricted, walking is difficult, thin tongue coating, string veins. Treatment: Regulating Qi, promoting circulation, harmonizing Ying and relieving pain. Recipe: Blood Stasis Soup with Addition and Subtraction: 15g of Ze Lan, 10g of Myrrh, 10g of Boswellia, 15g of Angelica, 9g of Dampi, 15g of Radix Paeoniae, 10g of Momordicae, 10g of Safflower, 9g of Qiang Wu, 25g of Aromatic Herb, 12g of Wu Yao. (2) Blood stasis and ligament obstruction: Blood stasis is limited to one side of the waist, with localized ecchymosis, obvious pressure pain, restricted lumbar movement, or abdominal distension, constipation. The tongue is dotted with stasis and the pulse is dazzlingly tight. Treatment: Promoting Qi, eliminating stasis, promoting menstruation and relieving pain. Formula: Body Pain and Stasis Removal Soup with Addition and Reduction. Musk 1.5g, Myrrh 10g, Boswellia 10g, Cinnamomum 10g, Sumac 10g, Ephedra 3g, Aromatic Herb 15g, Angelica 15g, Peach kernel 10g, Eucommia 15g, Panax ginseng 6g, Glycyrrhiza 15g. (3) Wind-cold dampness paralysis: Most of them have old history of lumbago, the patient gradually feels heavy pain in the lumbar region, unfavorable turning, obvious in case of weather changes, aggravated in case of cold, light tongue, white greasy coating, pulse Pale tongue, white and greasy coating, slow pulse. Treatment: Dispel wind and dispel cold, resolve dampness and clear the channels. Remedy: Duluxiaosheng Tang plus reduction. Doklam 15g, Gentiana macrophylla 15g, Fangfeng 15g, Cinnamon 3g, Paeonia lactiflora 15g, Hossein 3g, Angelica sinensis 15g, Eucommia globulus 20g, Niubizi 20g, Rhizoma Chuanxiong 12g, Radix Rehmanniae 15g, Radix Codonopsis pilosulae 15g, Rhizoma Atractylodis Macrocephalae 12g, Poria 15g, Glycyrrhiza glabra 3g. 2.Tui Na treatment is the key to treat this disease by correcting small joint disorders through tui na manipulation. get better results. (1): The patient is in prone position. First, roll, press and knead the patient for 5 minutes. (2), move qi and activate blood in the vertical direction of the muscle belly, use the flicking method to flick the muscles of the low back, focusing on flicking the sacrospinous muscles on both sides of the low back, and press and rub the painful points to improve local muscle spasm. (3), the tendon reset patient sitting, the doctor stands behind him, one hand thumb pressed on the side of the skewed spinous process, the other hand through the axilla clamped contralateral shoulder, do lumbar forward flexion, rotation, lateral flexion, straightening and other movements, this time can often hear a pop, colleagues thumb has a loose reset feeling. 3.Acupuncture treatment acupuncture can release muscle spasm, promote the dissipation of inflammation and edema, and relieve pain. It is often used to treat the degrees of Hua Tuo Pinch Point, Ah Yes Point, and the foot and sun bladder meridian on both sides, using the flat tonic and flat diarrhea method. 4, traction treatment patients lying on their back, often using fast traction after intermittent traction method, the initial traction force of 15 to 20 kg, gradually increase the traction strength after adaptation. 5.Physiotherapy can be given to the patient lumbar microwave. Infrared treatment. (B) Western medicine treatment The disease Western medicine to take oral pain medication, muscle relaxants, local nerve block treatment, after the above conservative treatment is not effective, should consider surgery. Prevention This disease should pay attention to prevention, maintain good sitting posture and living habits, take proper rest when this disease appears, avoid straining, pay attention to local warmth, prevent wind and cold invasion, strengthen functional exercise appropriately, enhance the strength of the lumbar back muscles, increase spinal stability, and restore the mechanical balance of the spine.