Low back pain has always been one of the common reasons for orthopedic patients to be seen. Perhaps the network or media propaganda is too powerful, or perhaps people have strengthened their attention to the emergence of low back pain, so many people immediately associate themselves with lumbar disc herniation once they have low back pain, and there are many patients who treat themselves on their own with the powerful Baidu, circle of friends and even anecdotal evidence. In fact, you do not have to blindly treat yourself as soon as the symptoms appear, there are many kinds of diseases that can trigger low back pain, maybe you can find out how to treat it from the Internet, or all kinds of various treatment methods want to try, but you can hardly identify the patient completely through the Internet which disease, differential diagnosis is the doctor’s skill. For patients with low back pain, one of the most confusing diseases is lumbar disc herniation and lumbar muscle strain. Here I also distinguish these two diseases through experience, but as I said, it is unlikely that this article can completely identify and diagnose them. The main purpose of this article is to give you a clear understanding of these two diseases, so that you do not blindly treat yourself blindly, and also hope that you do not delay treatment due to misdiagnosis. What is lumbar disc herniation and lumbar strain? A lumbar disc herniation is a series of symptoms caused by a herniated disc that compresses a nerve or nerve root due to long-term pressure on the disc, degeneration or trauma resulting in rupture of the disc’s annulus fibrosus. Lumbar disc herniation is the main cause of back and leg pain, especially in young and middle-aged patients. Lumbar disc herniation will have the following manifestations: 1. Low back pain: Low back pain is the first symptom that occurs in most patients with this disease, with an incidence of about 90%. A few patients have only leg pain without lumbar pain, so that not every patient will necessarily have lumbar pain. In addition, there are some patients who have low back pain first and then leg pain after a period of time, and then the low back pain reduces or disappears on its own, and only leg pain is present when they come to see the doctor. 2. Lower limb radiating pain: It is mainly due to mechanical and/or chemical stimulation of the spinal nerve roots. In mild cases, it manifests as radioactive tingling or numbness from the waist to the back and outside of the thigh and the front and outside of the calf, reaching the back of the foot or the bottom of the foot; it is usually tolerable. In severe cases, the pain is severe and electric shock-like from the waist to the foot, and is often accompanied by numbness. Any factors that increase abdominal pressure, such as coughing, straining to defecate, laughing, sneezing, lifting heavy objects, chronic coughing, etc., are likely to trigger lumbar pain or aggravate the already occurring lumbar pain. 3, scoliosis: This is a postural compensatory deformity adopted by patients with lumbar disc herniation to reduce pain. The lumbar vertebrae are bent to the left or right, and the spinous process can be found to be skewed by touching the spinous process in the middle of the back, but this is not a unique sign of lumbar disc herniation, and about 50% of normal people also have skewed spinal spinous process. 4, claudication: lumbar disc herniation can cause relative stenosis of the lumbar spinal canal, and the occurrence of claudication is mostly intermittent, i.e. pain and weakness of the lower limbs after walking a certain distance, and the symptoms can be relieved after bending or squatting to rest, and can still continue to walk. In addition, intermittent claudication is also a typical manifestation of lumbar spinal stenosis. 5, sensory numbness: some of the patients with lumbar disc herniation will not experience pain in the lower limbs, but only numbness in the limbs, or pain accompanied by numbness, which is mostly caused by the compression of the proprioceptive and tactile fibers of the nerves by the intervertebral disc tissue. Lumbar muscle strain is a chronic injury inflammation of the lumbar muscles and their attachment points of fascia or periosteum. The symptoms of lumbar muscle strain are relatively few and mainly manifest as lumbar pain, which is characterized by soreness or swelling of the lumbar region; the pain is aggravated by exertion and relieved by rest; the pain can be relieved by lumbar massage or by hitting the lumbar region with a fist; there are mostly clear pressure points in the lumbar region, mostly at the sacrospinous muscle, the posterior part of the iliac spine, the stop of the sacrospinous muscle after the sacrum or the transverse process of the lumbar vertebrae; compared with lumbar disc herniation, the shape and activities of the lumbar region are mostly abnormal, and there is no obvious lumbar muscle In contrast to lumbar disc herniation, the shape and movement of the lumbar region are not abnormal, and there is no obvious lumbar muscle spasm. Are lumbar disc herniation and lumbar strain two separate diseases? In fact, lumbar strain is more common than lumbar disc herniation. Lumbar muscle strain is a lesion of the muscles and soft tissues around the lumbar region, and if it is not effectively treated for a long time, its protective effect on the lumbar spine will be reduced, which may lead to a herniated lumbar disc. Likewise, after a lumbar disc herniation causes lumbar leg pain, it can also lead to changes in lumbar posture, which can cause lumbar muscle strain and further aggravate the symptoms of the herniation. Therefore, lumbar disc herniation and lumbar muscle strain are two diseases, but not independent, and not receiving reasonable treatment can cause a vicious circle. Why is it necessary to identify lumbar disc herniation and lumbar muscle strain? First of all, the two treatments are different: lumbar strain is often treated conservatively and generally does not require surgery. The main and most important treatment for lumbar muscle strain is to change the habits of work and life that aggravate lumbar muscle strain, and other treatments are only supplementary treatments. For lumbar disc herniation, although conservative treatment is also generally used when the first occurrence and symptoms are mild; however, surgery is needed when conservative treatment is ineffective, when symptoms are severe, with spinal stenosis and nucleus pulposus prolapse type, etc.