Acute lumbar sprain is caused by sudden indirect violence, such as overexertion of heavy objects or improper body position causing strain on the lumbar muscles, or joint misalignment, etc. Sprains mostly occur in the lumbosacral joint, sacroiliac joint, intervertebral joint or both sides of the sacrospinous muscle and other parts. The lumbosacral joint is the hub of the human body, and the sacroiliac joint is the bridge between the trunk and the lower limbs, so the pressure of weight and external impact are mostly concentrated in these parts, so there are more chances of injury. When the spine is flexed, the two sides of the extensor muscles (especially the sacrospinous muscles) contract to resist the weight and maintain the position of the trunk, such as excessive weight, easy to tear the muscle fibers; when the spine is fully flexed, mainly rely on ligaments to maintain the position of the trunk, such as excessive weight, easy to cause ligament damage. Excessive lumbar range of motion, the small intervertebral joints are overstretched or twisted, which can lead to joint misalignment or synovial impingement. Therefore, in a precise sense, the term “acute lumbar sprain” is inaccurate, and it is this vague diagnosis that leads to missed diagnosis and treatment, and ultimately to chronic lumbar strain or lumbar disc herniation. Due to the complexity of the lumbar structure, there are multiple joints involved. Therefore, when a lumbar sprain occurs, one or more joints may be misaligned or injured at the same time. If it is a simple ligament and muscle strain, the lumbar activity is not greatly restricted and forced position does not appear. Only in the case of joint misalignment and synovial nesting, such as lumbar small joint disorder and sacroiliac joint misalignment, will forced position appear. In clinical observation, this is often the case when a patient with acute lumbar sprain with sacroiliac joint misalignment, when the misaligned joint is rectified, he can stretch his chest and walk freely. From the cases collected, it seems that simple lumbar muscle and ligament injuries are rare. Therefore, the diagnosis of acute lumbar sprain should be replaced by a specific joint misalignment. The role of manual treatment is to rectify the displacement, activate blood circulation and disperse blood stasis, reduce swelling and pain, relieve urgency and spasm, relax the tendons and activate the ligaments, promote the dispersion of knots and peel off adhesions. The treatment should be early, accurate positioning, especially the direction of anatomical displacement should be clear, dexterous operation, as far as possible using the principles of mechanics and human physiological characteristics, steady force, i.e., the requirement of steady and strong, to avoid excessive force caused by injury, but also pay attention to the identification of the method. The treatment of acute lumbar sprain, for a long time, most people advocate massage therapy, think the effect is good. In fact, because the dislocation of the joint has not been rectified, the injured muscle group in a state of tension, massage is easy to cause local tissue spasm, edema, the next day the pain increased. The local closed treatment or physical therapy is uncertain, incomplete, long treatment time, easy to leave sequelae and become chronic lumbar muscle strain. For patients with simple lumbar muscle and ligament injury, they can heal themselves by bed rest and taking Panax notoginseng tablets, but for patients with joint misalignment, they must correct the joint misalignment and release the synovial inlay through orthopedic massage, so that the muscles can return to the normal state and be truly relaxed and repaired, which is the real effective treatment.