The adult spine is composed of 26 vertebrae, including 7 cervical vertebrae, 12 thoracic vertebrae, 5 lumbar vertebrae and the fused sacral and caudal vertebrae; between the two vertebrae is the intervertebral disc, consisting of cartilage plate, nucleus pulposus and fibrous ring, whose main component is collagen, the intervertebral disc can cushion the spinal movement of the pressure experience, absorb shock, protect the spinal cord, the lumbar intervertebral disc can also assist The lumbar intervertebral disc can also assist the lumbar region to complete the back and forth flexion and extension, and left and right rotation movements. The lumbar intervertebral disc herniation is caused by the degeneration of the intervertebral disc tissue, injury, rupture of the fibrous ring and extrusion of the nucleus pulposus from the ruptured fibers into the spinal canal and compression of the nerves due to trauma, long-term exertion, strain, uncoordinated force and improper posture of the patient’s back. It can cause pain, numbness, coldness, soreness, cramps, lumbar scoliosis, leg muscle atrophy, weakening, and even loss of ability to work. Third, the symptoms of lumbar disc herniation The lumbar disc herniation is divided into: bulge, protrusion, prolapse. The symptoms are various. Including all kinds of back pain symptoms, it is believed that the aseptic inflammation around the vertebral body stimulates the sympathetic and sensory nerves around the vertebral body. Lumbar disc herniation often has changes in the narrowing of the intervertebral space, which can cause misalignment of the small joints of the lumbar spine and damage to the joint capsule, and stimulation of sensory nerve endings in the joint capsule causing deep lumbar pain. Patients with lumbar disc herniation often have symptoms of lumbosacral pain, which is deeper and can be mild or severe. In light cases, the symptoms arise only after sitting for a long time; in heavy cases, the pain is unbearable, bed-ridden, painful when moving slightly, and extremely difficult to turn over. After resting in bed, the symptoms of low back pain gradually reduce or disappear, but some patients have lower limb symptoms after several days or weeks. Generally, 1/6-1/5 patients only have symptoms of low back pain without lower limb symptoms, and there are also patients who only have lower limb symptoms without low back pain symptoms. The degree of leg pain symptoms varies greatly, such as the early appearance of numbness and discomfort in the lower leg and foot; some start with pain in one lower limb with numbness and distress; some only have symptoms of distress and distension in the lower limb, and soon the symptoms appear on the other side, one focusing on one side light or the original side symptoms disappear. The upper lumbar disc herniation is mostly manifested as femoral neuralgia on the anterior side of the femur, and the lower lumbar disc herniation is mostly manifested as sciatica on the posterior side of the femur. Some patients have lumbar and leg pain symptoms at the same time; there are also lower extremity symptoms that appear and then the lumbar pain symptoms are reduced or disappear. Lower limb symptoms are often related to walking and standing, some patients show persistent pain and numbness, and the symptoms affect walking activities in heavy cases and paralysis of lower limbs in serious cases. Pathological staging and typing of lumbar disc herniation (1) Pre-protrusion: In this period, the nucleus pulposus may become fragmented due to degeneration and injury, or scar-like connective tissue, and the degenerated fibrous ring may become thin and soft and produce fissures. (2) Protrusion phase: When the disc is under increased pressure, the degenerated nucleus pulposus may protrude from the weakness or rupture of the annulus fibrosus. The herniated nucleus pulposus is bounded by a very thin fibrous annulus, which can produce severe clinical symptoms; ④ Prolapsed disc, where the herniated nucleus pulposus passes through a completely ruptured fibrous annulus and lies under the posterior longitudinal ligament. (5) In a free disc, the nucleus pulposus passes through the completely ruptured annulus fibrosus and posterior longitudinal ligament and lies free in the spinal canal or even in the intradural subdural space, compressing the cauda equina or nerve roots. (3) Late stage of herniation: fibrosis or calcification of the disc herniation. The intervertebral disc degenerates, the fibrous ring wrinkles, the vertebral space narrows, and the vertebral body osteosclerosis forms a bone flab. Nerve root damage, long-term compression can lead to adhesions, degeneration and atrophy of nerve roots. Hypertrophy of the ligamentum flavum, which is a secondary lesion, can lead to spinal stenosis. Intervertebral joint degeneration and hyperplasia, due to narrowing of the intervertebral space and increased compensatory loading of the intervertebral joints, can lead to arthritis and hyperplasia and other changes. Secondary spinal stenosis, due to the above changes can occur acquired spinal stenosis. V. What are the factors that can induce lumbar disc herniation? The basic factor that constitutes lumbar disc herniation is degenerative changes of the intervertebral disc, and the factors that induce lumbar disc herniation are roughly divided into the following categories: (1) Trauma: Acute injuries such as lumbar sprains do not directly cause lumbar disc herniation. But in the case of loss of lumbar back muscle protection, it is very likely to cause disc protrusion. (2) Excessive weight bearing: engaging in heavy physical labor and weight lifting often causes early degeneration of the intervertebral disc due to excessive load. When the spine weight 100Kg, the normal intervertebral disc gap narrowing 1.0mm, lateral expansion 0.5mm. and when the disc degeneration, negative the same weight, the vertebral gap narrowing 1.5-2mm, lateral expansion 1mm. (3) long-term vibration: car and tractor drivers in the work, long-term sitting and upside down state, the lumbar disc pressure increased by about double. Such long-term repeated disc pressure increase, can accelerate the degeneration or protrusion of the intervertebral disc. (4) the impact of bad posture: people in the completion of a variety of work, the need to constantly replace a variety of positions, including sitting, standing, lying and difficult to avoid a variety of non-physiological posture, the ability to withstand or a momentary failure to adapt to the transmission of external forces, can suffer trauma or cumulative injury. For example, the posture when lifting heavy objects is very important, because poor posture often induces the occurrence of this disease. (5) spinal deformity: congenital and secondary spinal deformity patients, because the intervertebral disc is not only unequal in width, and there is often torsion, which makes the pressure on the fiber ring is not the same, and easy to accelerate the degeneration of the intervertebral disc. The lumbar intervertebral disc herniation is mostly seen in young adults aged 20-40 years old, accounting for about 80% of patients, with more men than women. 95% of lumbar disc herniations occur in the 4th to 5th lumbar and 5th to 1st sacral intervertebral spaces, and the following clinical manifestations can occur. (1) Back and leg pain: Most patients have a history of trauma, exposure to cold or overexertion. When the disease starts, it often shows different degrees of lumbar pain first, only dull pain and soreness in mild cases, or difficulty in turning in bed in severe cases. Low back pain gradually decreases or subsides after resting in bed. After a few days and weeks of work, the pain is gradually felt as radiating pain in one side of the lower limb, and the pain increases when standing, walking, coughing, sneezing and using force to urinate and defecate. With conservative treatment, the symptoms may be relieved or even disappear completely. Later on, when the back is sprained, cold or strained again, the symptoms may recur again. With such repeated recurrence, the symptoms are progressively aggravated, the attack period is gradually prolonged, the interval between attacks is gradually shortened, and there may even be no obvious remission period. (2) Abnormal lumbar spine posture: reflex muscle spasm caused by lumbar pain can name the physiological anterior convexity of the lumbar spine to become smaller, disappear completely, or even become retroconvex. Thereafter, in order to reduce the compression of nerve roots by protrusions, more than 90% of patients may develop different degrees of scoliosis, with most convex to the affected side and a few convex to the healthy side. (3) Restriction of lumbar spine movement: due to reflex muscle spasm caused by pain. In mild cases, the activity of the spine is restricted when the spine is posteriorly extended and bent to the affected side; in severe cases, the patient is bedridden, has difficulty turning over, and even kneels in bed day and night. (4) pressure pain and radiating pain: more than 80% of patients with this disease have obvious pressure pain points next to the vertebral space where the rupture of the annulus fibrosus occurs, and the pain radiates to the affected lower extremity, even to the heel and toes. More than 90% of patients have pressure points located in the paravertebral area of the lumbar 4-5 interval and the lumbar 5-sacral 1 interval, which is one of the important means of clinical determination of the affected intervertebral space. (5) Positive straight-leg raise test and strong-strong test: this is an important test for the diagnosis of this disease. The former test is performed by straightening the knee joint and elevating the examined lower limb in this extended position, and the test is considered positive when the sciatic nerve pulling pain appears on the side before the job is elevated to 90°. The latter is examined by elevating the straight leg of the affected limb to the point where it will be painful, and extending the foot passively dorsally, and if sciatica occurs, it is considered positive. (6) Changes in skin sensation, muscle strength and reflexes of the lower limbs: compression of the lumbar nerve root by the herniated object can cause abnormalities in skin sensation, muscle strength and reflexes of the affected innervation area. The symptoms of neurological dysfunction vary because different intervertebral spaces of the herniated disc compress different lumbar nerve roots. Since more than 90% of the lumbar disc herniation seen clinically occurs in the 4-5 lumbar intervertebral space and the 5th lumbar and 1st sacral intervertebral space, it is common to see clinical numbness of the skin sensation in the lateral calf, lateral foot and bunion, and weakness of the dorsiflexion of the bunion, and abnormal knee tendon reflex or Achilles tendon reflex in 70-80% of patients (hyper, hypo or absent). Seven, who are prone to lumbar disc herniation 1, age, the disease generally occurs between the ages of 20 – 40 years, that is, the proportion of young adults prone to the disease accounted for about 80% of the overall incidence. 2, from the gender, lumbar disc herniation is mostly seen in men, because men are more physically active, more frequent, lumbar activity range. 3, from the body type, generally too obese or too thin people are prone to lumbar disc protrusion. 4, from the occupation, labor-intensive industrial workers are more common. 5, from the posture, every day often ambulatory work of office workers and often standing salesman, textile workers, etc. more common. Young people due to long-term sitting in front of the computer desk, so that the lumbar limbs in a long-term tension, fatigue injury and the onset. 6, from the living and working environment, if the environment is often humid or cold, also prone to lumbar disc protrusion. 7, from the different periods of women, prenatal, postnatal and menopause for women lumbar disc protrusion risk period. Eight, lumbar disc herniation self-care therapy young people can not underestimate the spinal health care, experts pointed out that due to excessive workload and lack of health care awareness, many people are young but have degenerative changes in the spine geriatric disease, the whole day is plagued by back pain. In addition to timely medical care and avoid a posture for too long, there is no better prevention and control measures? A few days ago, the reporter interviewed Beijing Sports University professor and kinesiologist Dou Wenhao on the prevention and treatment of lumbar spine disease, which is highly prevalent in office workers. Professor Dou said, the waist around the ring movement and backward walking, the treatment and prevention of lumbar spine pain is very effective. For long-term sedentary people, lumbar spine disease is very common, manifested as sometimes heavy, sometimes light, when the pain is aggravated by exertion, physical therapy can reduce pain, but can not get rid of the root of the disease. According to research in sports medicine, the lumbar ring exercise and backward walking are very effective in treating and preventing lumbar spine pain. The so-called circular movement, the basic action is as follows: legs slightly apart, two hands forked in the back of the waist, the waist as the axis of rotation around the body, if the pain is serious, you can move more slowly: first to the left, then to the right. This method is simple, but it works, so we suggest you try it. There is also a way, is currently more internationally promoted a treatment of lumbar spine disease exercise therapy, that is, backward walking. Backward walk when the two legs alternately step backward, enhance the strength of the posterior thigh muscle groups and lumbar back muscle groups, can make the lumbar ligament elasticity, lumbar spine stability, so that the bones, muscles, ligaments to restore the function, so that the lumbar spine pain can be reduced or even disappear. Backward walking has now been widely used for fitness, it is also suitable for back injury, lumbar muscle pain and poor cerebellar balance. Backward walking therapy is simple, easy to grasp, regardless of age can be exercised Backward walking should be 1 time a day in the morning and evening, each time 20 ~ 30 minutes, to be progressive. Lumbar spine pain is very strong if you can immediately backward walking exercise, can play a good role in pain relief, chronic lumbar spine patients who can adhere to long-term backward walking, two months will see good results, some patients can even be cured. It should be reminded that when walking backwards, people’s perceptual ability to space is significantly reduced, easy to fall, so the pace should not be too fast, and strive to walk steadily, both eyes should be leveled at the bottom in order to grasp the direction. In order to be safe, backwards walking, the best forefoot rubbing the ground alternately backwards. Can also take a partner approach, one person to go forward, the other backward walk, two people alternating rotation, mutual care. Professor Dou Wenhao said in reference to the speed of backward walking and the mastery of the amount of exercise, he suggested that the beginning of 60 steps per minute is better, healthy people should be controlled at 90 to 100 times per minute, the pulse of people with back pain, should be controlled than their own quiet increase of more than 10 times for the best. Nine, the prevention of lumbar disc herniation For lumbar disc herniation, the emphasis is on prevention. So, how to prevent lumbar disc herniation or prevent its recurrence? Pay attention to the rationality of the usual standing, sitting, labor posture and sleeping posture, correct bad posture and habits, strengthen exercise, enhance physical fitness, especially strengthen the functional exercise of the lumbar back muscles, because proper exercise can improve muscle blood circulation, promote metabolism, increase muscle reactivity and strength, loosen soft tissue adhesions, correct the imbalance between the intrinsic and extrinsic balance of the spine, improve the stability, flexibility and durability of the lumbar spine, Flexibility and durability, thus achieving good therapeutic and preventive effects, and in the cold and wet season should pay attention to keep warm to prevent the recurrence of the disease.