I. Overview
The posterior lumbar joint is composed of the inferior articular process of the superior vertebrae and the superior articular process of the inferior vertebrae. When the joint is not smooth due to degeneration, muscle fatigue and uncoordinated movement, especially in unprepared daily activities such as sudden turning or upright stretching, there may be widening of the joint space on one side, generating negative pressure and drawing the synovial membrane into the joint, which is caught between the joint surfaces when the waist is straightened, causing severe pain due to synovial membrane irritation.
II. Diagnostic points
1.More history of lumbar sprain, flashback, bending or immediate straightening of the waist.
2.Sudden unbearable severe pain in the lumbar region, afraid to move, expression of pain, almost complete loss of lumbar activity function.
3.The whole body lumbar muscle is in tension and rigid plate.
4.The lumbar region is in a rigid flexion position, posterior extension activity is obviously restricted, and there is pressure pain at the lumbar 4-5 or lumbar 5-sacral 1 spinous process and paravertebral area.
5. X-ray examination: asymmetric direction of posterior joint alignment, or lumbar lordosis and lateral curvature, unequal width of vertebral space from left to right.
Differential diagnosis
It must be distinguished from acute lumbar myofascial sprain. In acute lumbar myofascial sprain, the activities of the lumbar region are restricted in all directions and cause increased pain. The pressure points are more superficial. In acute posterior lumbar synovial impingement, anterior lumbar flexion is still possible, but excessive anterior flexion is not possible, and passive rotational activities and posterior extension of the lumbar region are restricted and cause increased pain, which is much more than lumbar myofascial sprain, with spasm or stiffness of the lumbar muscles and deep induration on both sides of the spinous process.
IV. Diagnostic hints
This disease should be considered for those who have a history of lumbar sprain, flashback or straight back immediately after bending, and unbearable and severe pain immediately after the injury.
V. Treatment methods
(A) Non-surgical treatment
1.Bed rest.
2.Orally take non-hormonal anti-inflammatory and pain-relieving drugs to release muscle spasm.
3.Local closure.
4.Traction.
5: Physiotherapy: electric excitation is feasible in the acute stage to relax the muscles, others such as ultrashort wave and microwave therapy should be applied in the recovery period or when chronic pain is present.
(B) Manipulation therapy
Commonly used techniques are: 1. massage technique. 2. inclined plate technique. 3. back method. 4. shaking method.
VI. Treatment tips
Manipulation is an effective method for treating synovial impaction of the small joints of the lumbar spine. If the diagnosis is clear, the implementation of manipulation can achieve immediate effect, but more than traction pain, and therefore should be first local closure and then manipulation better.