Symptoms of lumbar disc herniation I Low back pain and radiating pain of one lower limb are the main symptoms of the disease. Low back pain often occurs before leg pain, or both may occur at the same time; most of them have a history of trauma, or there may be no clear cause. The pain has the following characteristics: 1. The radiating pain is transmitted along the sciatic nerve and goes straight to the lateral calf, dorsum of the foot or toes. In the case of lumbar 3-4 interval herniation, radiating pain to the front of the thigh is produced due to compression of the lumbar 4 nerve root. 2.All actions that increase the pressure of cerebrospinal fluid, such as coughing, sneezing and defecation, can aggravate the lumbago and radiating pain. 3.The pain increases with activity and decreases after rest. Bed position: Most patients adopt lateral recumbency and flex the affected limbs; individual severe cases have pain in all positions and can only bend their hips and knees in bed to relieve symptoms. In combination with lumbar spinal stenosis, there is often intermittent claudication. Symptoms of lumbar disc herniation II Scoliosis deformity: the main bend in the lower back, more obvious when forward flexion. The direction of scoliosis depends on the relationship between the herniated nucleus pulposus and the nerve root: if the herniation is located in front of the nerve root, the trunk generally bends to the affected side. Left: If the herniated nucleus pulposus is located in front of the nerve root, the spine bends to the affected side, and the pain increases if the bend is to the healthy side. Right: The herniated nucleus pulposus is located anterior to the nerve root, and the spine is bent toward the healthy side, with the pain increasing if the bend is toward the affected side. Symptoms of lumbar disc herniation III Restricted spinal movement The herniated nucleus pulposus compresses the nerve roots, causing protective tension in the lumbar muscles, which can occur unilaterally or bilaterally. Due to the tension of the lumbar muscles, the physiological anterior convexity of the lumbar spine disappears. Anterior flexion and extension of the spine is restricted, and radiating pain to one lower limb may occur during anterior flexion or extension. Lateral bending is often restricted on only one side, whereby it can be differentiated from lumbar spine tuberculosis or tumor. Symptom 4 of lumbar disc herniation Lumbar pressure pain with radiating pain There is a limited pressure pain point next to the affected spinous process at the site of disc herniation, accompanied by radiating pain to the calf or foot, which is important for diagnosis. Symptoms of lumbar disc herniation V. Positive straight leg raise test Due to the difference of individual physique, there is no uniform degree standard for this test to be positive, and attention should be paid to the comparison of both sides. A positive test is when the affected side has limited leg elevation and feels radiating pain to the calf or foot. Sometimes numbness occurs in the affected leg while raising the healthy limb, which is caused by the pulling of the nerve on the affected side, and this is of greater value for diagnosis. Symptoms of lumbar disc herniation 6 Neurological examination When lumbar 3-4 herniation (lumbar 4 nerve root compression) is present, there may be decreased or absent knee reflex and decreased sensation in the medial calf. In the case of lumbar 4-5 herniation (lumbar 5 nerve root compression), there is hypoesthesia of the anterolateral dorsalis pedis of the lower leg, and there is often hypoesthesia of the extension and 2-toe muscle strength. In the case of lumbar 5-sacral 1 herniation (sacral 1 nerve root compression), there is hypoesthesia of the posterior and lateral calf, hypotonia of the 3rd, 4th and 5th toe muscles, and hypotonia or loss of Achilles tendon reflex. In severe cases of nerve compression, the affected limb may have muscle atrophy. Symptoms of lumbar disc herniation 7 If the herniation is large, or if it is central, or if the nucleus pulposus fragment ruptures and protrudes into the spinal canal, more extensive symptoms of nerve root or cauda equina damage may occur, and the numbness area on the affected side is often extensive and may include the affected hip, lateral femur, calf and foot below the plane of nucleus pulposus protrusion. Central type herniation often has nerve damage symptoms in both lower extremities, but one side is heavier; attention should be paid to check the sensation in the saddle area, which is often decreased on one side and sometimes on both sides, often with loss of control of urination, wet pants and bedwetting, constipation, sexual dysfunction, and even partial or major paralysis of both lower extremities.