passive
movements, although painful, are possible in all directions.

In the _lumbar_ region sprains are usually due to over-exertion in
lifting heavy weights, or to the patient having been suddenly thrown
backwards and forwards in a railway collision. The attachments of the
muscles of the loins are probably the parts most affected. The back is
kept rigid, and there is pain on movement, particularly on rising from
the stooping posture.

_Treatment._--Unless carefully treated, a sprain of the spine is
liable to cause prolonged disablement. The patient should be kept at
rest in bed, and, when the injury is in the cervical region, extension
should be applied to the head with the nape of the neck supported on a
roller-pillow. Early recourse should be had to massage, but active
movements are forbidden till all acute symptoms have disappeared. In
patients predisposed to tuberculosis, the period of complete rest
should be materially prolonged.

#Isolated Dislocation of Articular Processes.#--This injury, which is
most frequently met with in the cervical region and is nearly always
unilateral, is commonly produced by the patient falling from a vehicle
which suddenly starts, and landing on the head or shoulders in such a
way that the neck is forcibly flexed and twisted. The articular
process of the upper vertebra passes forward, so that it comes to lie
in front of the one below.

The pain and tenderness are much less marked than in a simple twist,
as the ligaments are completely torn and are therefore not in a state
of tension. The patient often thinks lightly of the condition at the
time of the accident, and may only apply for advice some time after
on account of the deformity. The head is flexed and the face turned
towards the side opposite the dislocation, the attitude closely
resembling that of ordinary wry-neck, only it is the opposite
sterno-mastoid that is tight. The bony displacement is best recognised
by palpating the transverse process of the dislocated vertebra. In the
case of the upper vertebrae this is done from the pharynx, in the lower
between the sterno-mastoid and the trachea. There is pain on
attempting movement, and tenderness on pressure, particularly on the
side that is not displaced, as the ligaments there are on the stretch.
There are often radiating pains along the line of the nerves emerging
between the affected vertebrae. As the bodies are not separated, damage
to the cord is exceptional. The lesi