The third lumbar transverse process syndrome is one of the common clinical causes of low back pain, which is caused by acute sprain and contusion or chronic strain of the lumbar region, resulting in localized myofascial thickening and adhesion and stimulation and compression of the posterior lateral branch of the lumbar nerve, mainly manifesting as low back pain, hip pain and medial thigh pain. The transverse process of the third lumbar vertebra is the longest, with the psoas major and psoas square muscles in front of the transverse process and the sacrospinous muscle on the dorsal side, and the middle layer of the lumbodorsal fascia and the transversus abdominis fascia are attached to the tip of the transverse process, so it is subject to high stress and more opportunities for injury. Acute and chronic injuries to the lumbar region result in pathological changes such as congestion, swelling and inflammatory exudation of the soft tissues around the transverse process. Stimulation of lumbar sensory nerves, causing myofascial spasm. If not treated in time, local soft tissue mechanization, fibrous hyperplasia and inflammatory adhesions occur, stimulating and compressing the adjacent microvascular nerve bundles, causing pain in the lumbar hip. The posterior branch of the 1st to 3rd lumbar nerve crosses the myofascia and travels dorsal to the transverse process. When the muscle fiber tissue attached to the transverse process is injured and produces adhesions and scarring, the nerve can be compressed and cause pain. Most patients have a history of injury, which is associated with a wide range of lumbar activities and weight bearing, especially when caused by frequent bending or sudden twisting; it is more likely to occur with uncoordinated movements. In acute injuries, there may be swelling, subcutaneous bruising, obvious tenderness, and even interspinous widening or spinous fissure, mostly due to multiple small injuries caused by stretching of the supraspinous ligament, with local bleeding and exudate, and scarring and tissue hyperplasia after repair. Microscopically, lymphocytic infiltration, thickening of small vessel walls, nerve degeneration and calcium deposits in the soft tissue can be seen. The pain is more frequent on both sides of the waist, and the degree and nature of the pain varies, increasing in the morning, during exertion, when bending over, and difficult to get up after sitting for a long time, and slightly relieved after activity. The pain is mostly persistent. Some patients complain of pain radiating to the ipsilateral spinous process or even to the buttocks and lower limbs, and in severe cases, they cannot lie on their backs and have difficulty turning over and walking. A small number of patients have intermittent claudication. In chronic lumbar pain, lumbar movement is not restricted, while in acute lumbar pain, lumbar movement is significantly restricted and the lumbar muscles on both sides are in protective spasm. There may be limited pressure pain at the top of the transverse process of the third lumbar vertebra, and some patients may have ipsilateral lower limb reflex pain. A hard fibrous nodule of 1 to 2 cm can be felt at the pressure point (not obvious in fat people). The posterior border of the gluteus medius and the anterior border of the gluteus maximus can be palpated as a bulging mass with obvious tenderness, which is the tense and spastic gluteus medius. The straight leg raise test may be positive, but the strengthening test is negative. Tension of the adductor femoris is obvious in some patients because the adductor femoris is innervated by the foraminal nerve from lumbar 2 to 4. When the posterior branch of the spinal nerve from lumbar 1 to 3 is stimulated, it can reflexively cause tension spasm of the adductor femoris. X-ray examination: generally no abnormal changes, sometimes the third lumbar transverse process is longer or asymmetrical, or the tip of the transverse process is slightly dense area. General treatment: reduce bending activities, can be applied externally to reduce swelling and pain medication, generally do not advocate massage. In the chronic stage, physical therapy and acupuncture can be used, and generally conservative treatment has certain effect. Analgesic drug therapy: Nedimethasone is a non-steroidal anti-inflammatory drug, which is a non-acidic drug precursor. It is weakly active in its original form and is rapidly absorbed and metabolized after oral administration. Since there is no acid-base polar group in the drug molecule, it does not directly stimulate the gastrointestinal mucosa and does not destroy the protective mechanism of the gastric mucosa, and the drug in its original form does not inhibit the synthesis of prostaglandins in the stomach, which is less stimulating to the stomach and intestines. Diclopramide has strong analgesic, anti-inflammatory and antipyretic effects and is rapidly absorbed and excreted. It is used clinically to treat a variety of pain and cancer pain, and is also used to treat rheumatoid arthritis and lupus erythematosus. It is contraindicated in the first trimester of pregnancy and should be used with caution in patients with hepatic or renal dysfunction and a history of ulcers. Naproxen is a non-steroidal anti-inflammatory drug with rapid and complete absorption, used for the treatment of moderate pain, gout and various arthritis. It is used to treat moderate pain, gout and various kinds of arthritis. Naproxen can be used for people who are intolerant to aspirin and anti-inflammatory pain to obtain better results. This drug and aspirin and other non-steroidal anti-inflammatory drugs have cross-allergic, combined with benzosulfan can prolong its plasma t 1/2, occasionally see gastrointestinal bleeding, therefore, peptic ulcer patients are prohibited. The third lumbar transverse process injection therapy: is a common treatment for this disease, through the local administration of drugs to cut off the signal transmission of inflammatory stimuli, improve local microcirculation, eliminate muscle spasm, and inhibit the infiltration of inflammatory mediators. The patient lies prone, a pillow is placed under the abdomen, the skin is routinely disinfected, a 25G 8 cm long puncture needle is used, the puncture point is set at 3 cm next to the inferior edge of the spinous process of the third lumbar vertebra, the needle is inserted vertically through the puncture point, there is a slight resistance when passing through the skin and subcutaneous tissue, and the site of the lumbar muscular membrane is when there is a sudden and significant pain, and the drug is injected around the muscular membrane when there is no blood in the aspiration, and then the needle is continued to the surface of the transverse process of the lumbar vertebra to inject the remaining Then continue to inject the remaining drug into the transverse surface of the lumbar spine. The patient feels the swelling of the injection site and the effect is better when it spreads to the hip, medulla, flexor side of the lower limb or inguinal region. Surgical treatment: If the non-surgical treatment is not effective after strict scientific treatment, if the long-term pain affects work and life, or if the symptoms are too severe for non-surgical treatment, surgical treatment can be used. If the transverse process is too long, transverse process resection can be performed in parallel. Chinese medicine therapy: The treatment of this disease is mainly based on drugs that activate blood circulation and remove blood stasis, warm the meridians and open the ligaments. Commonly used formulas include: Strong waist powder, tonifying rheumatism soup, osteophyte pill, and compound strychnine powder. Manual therapy : Manual therapy can regulate Yin and Yang, move Qi and Blood, unblock meridians, soothe tendons and relieve pain, and is an important means of treating this disease. Shi Wenjie “5” believes that the early stage of the lesion is based on gentle light stimulation, which can activate blood circulation, eliminate blood stasis, reduce swelling and pain, improve the blood circulation of the surrounding soft tissues, and release muscle tension. In the later stage, the stimulation can be increased, but only to the extent that the patient can tolerate it, which can peel off the adhesions and soften the scar tissue. Acupuncture therapy: Acupuncture treatment can loosen local adhesions, release local neurovascular and muscle compression symptoms, and improve local blood circulation by stimulating the regulation of tissue cells. Small acupuncture: In patients with a long or recurrent history, the pathophysiological changes such as scar adhesions secondary to repeated injuries to the transverse processes of the third lumbar vertebra are relatively obvious, and the nerve branches are embedded and the blood supply of the nerve itself is affected, and there are mostly hip and leg symptoms. Using the surgical effect of the small needle knife, the adhesions are cut and the muscles are loosened to restore the static and dynamic balance of the muscles, thus improving local blood circulation and reducing the concentration of local pain-causing substances.