Lumbar facet joint disorder, also known as lumbar facet joint synovial incarceration, is a common condition in orthopedic clinics, especially in young adults. It is often caused by uncoordinated rotational movements in daily life, such as suddenly turning over in bed, standing up after squatting, and sneezing suddenly, and usually has no obvious traumatic factor. Because the lumbar facet joints are arranged in a coronal position, when the lumbar spine is flexed or rotated, the synovium may be squeezed between the articular surfaces, resulting in incarceration in the upright position. X-rays may show straightening of the lumbar spine curvature or deviation of the spinous process.
In terms of symptoms, patients may feel stiffness in the lower back, limited movement in bending over, difficulty sitting and lying down, and no symptoms of sciatica. In severe cases, patients may need to support their waist with their hands to walk. When examining the lower back, tender points can be found. The ancient book of Chinese medicine "Golden Kuiyi" mentions: "The waist is all about the body, bending, stretching and pitching, all of which are uncontrollable." If there is an injury, the blood will be condensed, the meridians will be stagnant, and it will be painful and cannot be turned to the side. "This suggests that blockage of blood and blood meridians is the main pathogenesis of low back pain. Traditional Chinese medicine classifies lumbar facet joint disorder as the category of "injured tendons", and believes that its pathological process involves "bone misalignment and tendon skipping". In clinical practice, the author usually chooses to use the sitting spinal rotation method or the three-move method combined with the squatting method**. Both methods have achieved satisfactory results. Seated spinal rotation method.
* Before the waist relaxation technique, the patient lies on his stomach, uses the palm of his hand to perform the massage method on the waist from top to bottom several times, uses the rolling method around the tender point**, and then gradually moves to the painful area, and then, use the rolling method along the direction of the sacrospinous muscle fiber on the affected side, back and forth 3 4 times;Push and rub 20 30 times continuously with the base of the palm of the hand on the left and right and up and down of the sore place in the lower back;Rub the waist Yangguan, kidney Yu, and Weizhong acupoints, and take soreness as the degree;Dial the sacrospinous muscles on the left and right sides of the lumbar pain point 20 30 times;Finally, apply the kneading method for 1 minute.
The patient sits upright on a square stool, the assistant supports and holds down the base of the thigh on the unaffected side, and the surgeon sits behind the patient. On the left side, for example, the patient has the left hand on the right abdomen and the right hand on the left shoulder, bending the body forward to the maximum angle. The surgeon's right hand presses next to the spinous process of the crooked lumbar lesion segment, holds the patient's right elbow with the left hand, and pushes the patient's body slightly to the left, the patient rotates the body to the left, to the maximum, the surgeon's right thumb pushes the crooked spinous process hard, and the two hands coordinate the action, and the reduction is successful when the "click" sound is heard or the spinous process under the thumb has a sense of dislocation, and the patient's tenderness is reduced. Finally, the ligaments around the spine are combed from top to bottom, and the reduction is complete. Usually, after the rehabilitation, the patient is instructed to rest in bed for 3 days, get out of bed and protect the waist circumference for 1 week, and the maneuver is once a week, and it is generally cured after 1 or 2 times.
This method can play a role in relaxing the tendons and channels, invigorating blood and dispersing stasis, smoothing the joints, correcting the staggered seams, correcting the intervertebral joint disorders, and restoring the balance of the physiological function of the spine. The technique should be gentle, deep, from light to heavy, step by step, and avoid using violence to avoid aggravating the waist injury.
Three-move method combined with squatting method.
Before the technique, first perform the rubbing method, rolling method, and rubbing the acupuncture points to loosen the waist.
Three moving methods, one is to lift the shoulder and push the waist, that is, the patient is in the prone position, the surgeon stands on the healthy side of the patient, lifts the patient's shoulder with his left hand, and pushes the affected part of the waist with his right handThe second is to move the leg and push the waist, that is, the patient is in the prone position, the surgeon lifts the patient's thigh with his right hand, and pushes and presses the affected part of the waist with his left handThe third is to lift the shoulders and push the buttocks, that is, the patient lies on the side, the upper leg bends the knee and the hip, the lower leg is straightened, the surgeon moves the shoulder backward with one hand (or elbow), and pushes the hip forward with the other hand, so that the waist is twisted, and after pushing and moving several times, the patient is relaxed, and then the surgeon gradually exerts force, and when there is a sense of fixation, he suddenly pushes it with skillful force, and the waist can often make a "cluck" sound at this time.
When operating the squat method, make the patient face the wall after getting out of bed, lift both upper limbs and chest wall close to the wall, separate the lower limbs, support the patient's armpit protection with both hands, and ask the patient to do squatting and standing movements 5 to 6 times. Then ask the patient to do a forward and backward extension of the lumbar spine to observe whether the lumbar spine is flexible and the pain is reduced.
After the manipulation is completed, the patient is instructed to rest in bed for 3 days, get out of bed and protect the waist circumference for 1 week, and the manipulation is done once a week, and it is generally cured after 1 or 2 times.
This method is in line with the principle of equal emphasis on muscles and bones and doctor-patient cooperation in traditional Chinese medicine. The passive ** led by the former French doctor can play a role in relaxing the tendons and channels, invigorating blood circulation and dissipating stasis, smoothing the joints, and correcting the wrong seamsPost-French patient-led initiative** can further correct residual deviation, eliminate pain and discomfort, enable patients to actively exercise, restore confidence, and promote coordinated movement of joints throughout the body.
In addition, the following four points need to be paid attention to: first, lumbar spine X-ray examination should be routinely performed before **Second, if the symptoms of low back pain are mild to moderate, choose the sitting spinal rotation method, and for those with severe low back pain symptoms, choose the three-move method and squat methodThird, it is forbidden for the elderly and frail with many underlying diseases;Fourth, people with lumbar osteoporosis should not use it.