The third lumbar transverse process syndrome is a disease with chronic low back pain or low back and hip pain as the main manifestation, and is one of the common clinical low back pain disorders. It is characterized clinically by significant pressure pain at the transverse process of the third lumbar vertebra and is a type of lumbar myofascial strain. The normal lumbar spine is physiologically convex, and the apex of the convexity is located in the third lumbar vertebra. The transverse processes of the five lumbar vertebrae are subject to varying degrees of tension, length and direction, and the transverse processes of the third lumbar vertebrae are the longest and are subject to the greatest tensile stress, and the ligaments, muscles and fascia attached to them are subject to great tension, so the soft tissues here are most easily damaged. Due to improper treatment of acute injury or chronic strain causing scar adhesions around the transverse process, fascial thickening, ligament contracture and other pathological changes, so that the neurovascular bundle through the myofascial hand to ‘stuck pressure’ and symptoms appear. The transverse process of the lumbar spine is the attachment of the anterior layer of the lumbar dorsal fascia. There are intertransverse muscles and intertransverse ligaments between each transverse process, and the transverse process is the starting and ending point of the lumbar square and transverse spine muscles, and the internal oblique muscle and transverse abdominis muscle through the tendon membrane also start here, which play an important role in the movement and stability of the low back. The gluteal epicutaneous nerve emanates from the L1-3 intervertebral foramen, penetrates the intertransverse ligament bone fiber pore, travels on the back of the L1-3 transverse process, and clings to the periosteum and reaches the intertransverse process sulcus, so lesions in the transverse process of the third lumbar vertebra can present pain in the gluteal region and the posterior aspect of the thigh with the gluteal epicutaneous nerve. The posterior aspect of the transverse process of the third lumbar vertebra is immediately behind the posterior branch of the second lumbar nerve root, and when bending forward and to the opposite side, this posterior branch is provoked by the transverse process or is abraded and causes pain and numbness in the innervated area, which can also involve the anterior branch of the second lumbar nerve and cause reflex pain, reaching the buttocks and anterior thighs. The lateral femoral cutaneous nerve trunk of the lumbar plexus nerve passes deep in front of the transverse process of the third lumbar vertebra and is distributed to the lateral thigh and knee. If the transverse process is too long, too large, or accompanied by fibrositis, this nerve can be involved and lateral femoral cutaneous neuralgia can occur. If the lesion affects the nearby foramen ovale nerve, the pain may also be present in the hip or thigh. Clinical manifestations Symptoms: The pain can be lumbar or severe, with limited movement, which can affect daily life and work in severe cases. Sitting and standing for a long time can cause pain and discomfort in the lower back and hip area. The pain can reach the front of the buttocks and thighs. It is not painful to lean back, but limited to bend to the opposite side. The main pain is low back pain and low back and hip pain. In a few patients, the pain extends to the posterior femur, below the knee, the pole of the adductor muscle and the lower abdomen, and in some cases, the low back and hip pain radiates along the thigh to the lateral calf, but there is no intermittent claudication. Signs: The important sign is the outer edge of the transverse process of the third lumbar vertebra, which corresponds to 4 cm next to the spinous process of the third lumbar vertebra, and the tip of the transverse process can be palpated with obvious pressure pain and restrictive muscle tension or muscle spasm, especially in lean and long patients. When pressed, the corresponding lumbar nerve and branches are stimulated and cause radiating pain in the area of innervation. About half of the patients have varying degrees of pressure pain in the contralateral transverse process or other parts of the spine. Diagnostic points: 1. History of lumbar trauma or strain injury. 2, sensitive pressure pain at the tip of the transverse process of the third lumbar vertebra and palpable nodules. 3, Tense strips combined with tension in the internal femoral retractors were felt at the posterior edge of the gluteus medius muscle. 4, The x-ray examination shows that the transverse process of the third lumbar vertebra is too long, asymmetric from left to right, or tilted backward. 5. The disease needs to be differentiated from lumbar disc herniation, acute sacroiliac joint sprain, and pear-shaped muscle injury. Treatment measures: 1. For those with mild symptoms, physiotherapy, acupuncture, massage and topical drugs and oral anti-inflammatory and analgesic drugs are effective. 2, obvious symptoms of the third lumbar transverse process around the tip of the anti-inflammatory analgesic liquid injection, generally 1-3 times can often achieve better therapeutic results. 3, the longer history of the disease with needle knife relaxation treatment. 4.If conservative therapy is not effective, surgery can be considered to remove the overgrown transverse process tip and the surrounding inflammatory tissue.