Etiology classification: chronic low back pain (a) acute and chronic injuries 1, acute injuries such as spinal fractures, ligaments, muscles, joint capsule tears, acute disc herniation, etc. 2, chronic injury such as ligamentitis, muscle strain, proliferation and degeneration of spinal bones and joints, spondylolisthesis, etc. (2) Inflammatory lesions Inflammatory lesions are divided into bacterial inflammation and non-bacterial inflammation. 1, bacterial inflammation can be divided into purulent and atopic infections such as spinal tuberculosis. Purulent infections are mostly seen in intervertebral space infections, epidural abscesses, and vertebral osteomyelitis. 2, non-bacterial inflammatory diseases rheumatic myofibrositis, rheumatoid arthritis, 3rd lumbar transverse synovial syndrome, ankylosing spondylitis, can store joint dense osteitis. (C) degenerative changes of the spine such as disc degeneration, small joint degenerative osteoarthritis, secondary spinal stenosis, senile osteoporosis, pseudosynovitis and spinal instability. (D) abnormal bone development scoliosis deformity, hemivertebral body, narrow discontinuous slippery guinea pig, hunchback, can skeletal lumbarization or lumbar dice, spina bifida and hooked spine, horizontal dice bone, lower limb unequal length, flat feet. (E) poor posture prolonged ambulatory work or bending work, pregnancy, obesity caused by large abdominal. (F) Tumors Bone and soft tissue tumors, bone marrow or nerve tumors, etc. (vii) Involvement pain caused by visceral diseases Gynecological pelvic diseases, prostate diseases, etc. can cause lower back pain, kidney diseases such as stone J tumor, renal prolapse, pyelonephritis and retroperitoneal diseases such as abscess, hematoma, etc. can cause low back surging, liver unit and heart disease can cause back pain. (H) mental factors With the progress and pace of society, such diseases are gradually increasing, such as chronic fatigue syndrome, mental allergy spondylitis, neurasthenia, plague, depression. Clinical characteristics: Low back pain caused by different diseases has different characteristics. The following briefly describes the clinical characteristics of common diseases causing low back pain: 1. Spinal lesions (1) vertebral fractures have an obvious history of trauma and are mostly due to a fall from a height, with the foot or hip landing first, with pressure pain and percussion pain at the fracture site, and the spine may have a posterior or lateral protrusion deformity with impaired movement. (2) Intervertebral disc herniation, more common in young adults, to the lumbar. ~ sacral. Easy to occur. There is often a history of heavy lifting or sprains, which can be sudden and slow onset. The main manifestations are lumbago and sciatica, both of which can exist simultaneously or separately. Sometimes the pain is severe, aggravated by coughing and sneezing, and relieved by bed rest. There may be numbness, coldness or intermittent claudication in the lower limbs. (3) Proliferative spondylitis: also known as degenerative spondylitis, mostly seen in patients over 50 years of age, who feel lumbago, soreness, stiffness and difficulty moving in the morning, and the pain improves after moving the lumbar region, but the lumbago worsens again after too much activity. The pain is obvious in the evening. It can be relieved by lying down, the pain is not severe, there is a comfortable feeling when tapping the lumbar area, and there is no obvious pressure pain in the lumbar spine. (4) Tuberculous spondylitis: It is the most common disease in infectious spondylitis, and the lumbar spine is the most susceptible, followed by the thoracic spine. Back pain is often the first symptom of tuberculous spondylitis. The pain is confined to the site of the lesion. The pain is vague, dull or aching, obvious at night and intensifies after activity, accompanied by low fever, night sweats, weakness and poor circulation. In the late stage, there may be spinal deformity, cold abscess and spinal cord compression symptoms. (5) septic spondylitis: this disease is rare, often due to sepsis, trauma, lumbar spine surgery, lumbar puncture and discography infection. Patients feel severe low back pain, with obvious pressure pain percussion pain, with chills and high fever and other symptoms of systemic toxicity. (6) Spinal tumor: Metastatic malignant tumors are common, such as metastasis of prostate cancer, thyroid cancer and breast cancer, or multiple myeloma involving the spine. It is manifested by intractable low back pain, which is intense and persistent, difficult to be relieved by rest and drugs, and radiating nerve root pain. 2, paraspinal tissue lesions (1) lumbar muscle strain: often due to ‘incomplete treatment of lumbar sprain or cumulative injury, patients feel lumbosacral soreness and dull pain, relieved at rest and aggravated after exertion. Especially the pain is obvious when working bent over, while the pain can be relieved when stretching or tapping the lumbar region. (2) Lumbar muscle fibrositis: It is often caused by cold, humidity and chronic strain, resulting in edema and fibrous degeneration of the fascia and muscle tissue of the low back. Most patients feel diffuse pain in the lumbar back, mainly in the muscles on both sides of the lumbar spine and above the iliac crest, which is worse in the morning and improves after a few minutes of activity, but the pain increases again after too much activity. The pain is relieved by tapping on the lumbar region. 3, spinal nerve root lesions (1) spinal cord compression: seen in primary or metastatic tumors in the spinal canal, epidural abscesses or disc herniation. The main manifestation is nerve root irritation sign, patients often feel neck and back pain or lumbar pain, and along one or more spinal nerve posterior root distribution area radiation, pain is intense, burning-like or cramp-like pain, spinal activity, cough, sneezing aggravated. There is some localization of pain and there may be sensory disturbance. (2) Subarachnoid hemorrhage: blood from the subarachnoid space can cause severe low back pain when the spinal membrane and posterior spinal nerve roots are stimulated. (3) Lumbosacral radiculitis: mainly pain in the lower back and lumbosacral region with stiffness, pain radiating to the buttocks and lower limbs, obvious pressure pain in the lumbosacral region, segmental sensory disorders in severe cases, weakness of the lower limbs, muscle atrophy and hypotonic reflexes. 4, low back pain caused by visceral diseases (1) urinary system diseases: nephritis, pyelonephritis, urinary tract stones, tuberculosis, tumors, renal prolapse and hydronephrosis and many other diseases can cause low back pain. Different diseases have their different characteristics. Nephritis presents deep distending pain, located in the lumbar rib triangle, with slight percussion pain; pyelonephritis has more distinct lumbar pain and more obvious percussion pain; renal abscess is mostly unilateral lumbar pain, often accompanied by local muscle tension and pressure pain; kidney stone is mostly colic, with intense percussion pain; lumbar pain caused by kidney tumor is mostly dull pain or swelling pain, sometimes colic. (2) Pelvic organ diseases: prostatitis and prostate cancer in men often cause pain in the lower lumbosacral region, accompanied by frequent and urgent urination and difficulty in urination; chronic adnexitis, cervicitis, uterine prolapse and pelvic inflammatory disease in women can cause pain in the lumbosacral region, accompanied by a feeling of lower abdominal cramping and pelvic pressure pain. 5, digestive system diseases The afferent fibers of digestive tract and organs enter the same spinal cord segment as the afferent fibers of certain skin area, so the visceral afferent pain sensation stimulates the excitation of the afferent fibers of the skin area, causing inductive pain. Gastric and duodenal ulcers and chronic perforation of the posterior wall directly involve the peri-spinal tissues and cause painful muscle spasms in the low back. Along with epigastric pain, pain in the region of the lower thoracic upper lumbar spine may occur. In acute pancreatitis, there is often radiating pain on the left side of the low back; one quarter of pancreatic cancers may present with low back pain, which is relieved when sitting in an anteriorly inclined position and worsened when lying in a supine position. Ulcerative colitis and Crohn’s disease are often accompanied by lower back pain along with digestive tract dysfunction. 6, respiratory system diseases such as pleurisy, tuberculosis and lung cancer can cause pain in the posterior chest and lateral thoracic scapula. Back pain is often accompanied by respiratory symptoms and signs, and pleural lesions are often aggravated by deep breathing, while the spine itself has no lesions, no pressure pain, and no restriction of movement Accompanying symptoms: 1, low back pain with spinal deformity, post-traumatic deformity is mostly due to spinal fractures, misalignment; since childhood, there are deformities are mostly due to congenital spinal diseases; slow onset is seen in spinal tuberculosis and ankylosing spondylitis. 2, low back pain with restricted movement, seen in spinal trauma, ankylosing spondylitis, acute sprain and contusion of the soft tissues of the low back. 3, low back pain with prolonged low-grade fever is seen in spinal tuberculosis, rheumatoid arthritis; with high fever is seen in septic spondylitis and paravertebral abscess. 4.Lower back pain with frequent urination and incomplete urination are seen in urinary tract infection, prostatitis or prostatic hypertrophy; severe pain in the lower back with hematuria is seen in kidney or ureteral calculi. 5.Lower back pain with belching, acid reflux and epigastric distension is seen in gastric or duodenal ulcer or pancreatic lesions; lower back pain with diarrhea or constipation is seen in ulcerative colitis or Crohn’s disease. 6. Low back pain with abnormal menstruation, dysmenorrhea and excessive leucorrhea are seen in cervicitis, pelvic inflammatory disease, ovarian and adnexal inflammation or tumor. The time of onset of pain can be accurately pointed out in patients with trauma or infection, while in chronic cumulative lumbar injury, only the approximate time can be stated. 2. The onset of pain varies according to different diseases. Trauma to the low back, acute lesions of organs, such as kidney stones, biliary pancreatic disease, etc. have a rapid onset; tuberculosis of the lumbar spine, lumbar muscle strain, etc. have a slow onset. In addition, low back pain caused by organ radiation has certain characteristics, such as cervicothoracic back pain should be considered whether it is due to pleuropulmonary lesions; mid-lumbar back pain should be considered gastrointestinal, pancreatic and urinary system diseases; lumbosacral pain should pay attention to prostatitis, uterus, adnexa and other lesions. 4, the nature of pain lumbar spine fracture and acute sprain of lumbar muscle is mostly sharp pain, septic inflammation is throbbing pain, lumbar muscle old injury is swelling pain,. Kidney stones are felt as lumbar colic. 5, the degree of pain Acute trauma, inflammation, urinary stones, spinal tumors compressing nerve roots, etc. pain is intense; chronic strain of the lumbar muscle, myofibrosis and pain caused by inflammation of the pelvic organs are generally mild and vague. 6.Pain triggering and relieving factors Lumbar muscle strain is mostly aggravated by exertion and excessive activities and relieved when resting; rheumatic low back pain is often triggered when the weather becomes cold or when working in a humid and cold environment; pelvic gynecological diseases often aggravate lower back pain due to congestion during menstruation; lumbar disc herniation is aggravated when coughing and sneezing and forceful urination and defecation. 7.The evolution of pain Chronic lumbar muscle strain and lumbar muscle fibrosis are benign processes that occur repeatedly and are relieved repeatedly without leaving deformities; pain caused by disc herniation, spinal tuberculosis and tumor is progressively aggravated. 8.Concomitant symptoms In addition to low back pain, whether there are symptoms of corresponding organ lesions. See the relevant content of this section. 9.Occupational characteristics Sand tumblers, porters, underground miners, due to heavy lifting, bending work and working in humid environment. Easy to produce low back pain; engaged in certain sports, such as volleyball, gymnastics, weightlifting. Judo. Wrestling is easy to cause low back injury and cause low back pain. Exercise method: The principle of bending knees and rolling therapy is: bending knees and holding legs so that the body forms a circular mass, which can stretch the muscles of the low back to stretch state. When rolling on the bed, let the muscles of the low back and the bed contact, mechanical massage occurs, muscle fibers elongate, blood vessels expand, blood circulation accelerates, nutrients and oxygen transported to the low back increases, the resistance of the low back muscles increases, stretching open the contracted muscles and ligaments, preventing scar adhesion and muscle atrophy, maintaining the normal function of the low back, and the symptoms of low back pain gradually reduce or disappear. Low back pain exercise Prevention: 1, after maintaining the same sitting or standing posture for a long time, you should relax your waist or stretch your waist limbs. 2, moderate change in the posture of the neck, it is best to rest a few minutes every hour of work. 3, too obese people, should be appropriate to lose weight to reduce the burden on the waist. 4, should not use too soft mattress, a harder mattress is beneficial to the waist. At the same time, try not to lie prone, which is not good for the waist. 5, when carrying heavy objects, as close as possible to the side. 6, try to be careful when bending or twisting the waist, or avoid bending or twisting the waist as much as possible. 7.Long-term physical and mental strain is also a cause of low back pain, so the way to prevent it also includes trying to relax yourself in your spare time.