A herniated lumbar disc refers to a set of symptoms caused by a herniated nucleus pulposus of the lumbar spinal disc compressing its surrounding nerve tissue. Lumbar disc herniation, also known as lumbar disc fibrous annulus rupture or lumbar disc nucleus accumbens. It is a common disease in which the nucleus pulposus protrudes after the rupture of the fibrous ring and presses on the spinal nerve roots, causing back and leg pain. I. Clinical manifestations: (a) 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; there may be leg pain only; there may be a history of trauma, or no clear cause. The pain has the following characteristics: 1. The radiating pain is transmitted along the sciatic nerve and reaches the lateral calf, dorsum of the foot or toes. In case of lumbar 3-4 interstitial herniation, radiating pain to the front of the thigh is produced due to the 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 limb; individual severe cases have pain in all positions and can only bend the hip and knee in bed to relieve the symptoms. In combination with lumbar spinal stenosis, there is often intermittent claudication. (B) Scoliosis deformity: the main bend in the lower back, more obvious when forward flexion. (iii) Restricted spinal movement The nucleus pulposus protrudes and 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. The anterior flexion and posterior extension of the spine is restricted, and radiating pain to one lower limb may occur during anterior flexion or posterior extension. Lateral bending is often restricted on only one side, according to which it can be differentiated from lumbar spine tuberculosis or tumor. (iv) Lumbar pressure pain with radiating pain There is a limited pressure pain point between the spinous processes on the affected side of the herniated disc, with or without radiating pain to the calf or foot, which is important for diagnosis. (e) Positive straight leg elevation test 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 point can be considered as a larger disc herniation. (VI) 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 disappearance of the Achilles tendon reflex. In severe cases of nerve compression, the affected limb may have muscle atrophy. If the herniation is large, or if it is central, or if the nucleus pulposus fragments protrude into the spinal canal, there may be more extensive nerve root or cauda equina damage symptoms, and the numbness area on the affected side is often more extensive, including the affected hip, lateral femur, calf and foot below the plane of nucleus pulposus protrusion. Central type protrusion often has symptoms of nerve damage in both lower extremities, but one side is more severe; attention should be paid to check the sensation in the saddle area, which is often diminished on one side and sometimes on both sides, often with loss of control of urination, wet pants bedwetting, constipation, sexual dysfunction, and even partial or major paralysis of both lower extremities. Small joint disorder There is a kind of lumbar injury, immediately after the injury occurs unusually severe back pain. Patients are often bent sideways, the waist can not straighten, afraid to move, afraid of others to touch, often misdiagnosed as acute lumbar sprain. In fact, the exact diagnosis should be lumbar joint synovial imbrication, or called lumbar posterior joint disorder, commonly known as your small joint disorder. Second, differentiation: the upper and lower synapses of adjacent vertebrae constitute the posterior lumbar joint, which is a synovial joint with nerve distribution. When the relationship between the upper and lower synapses of the posterior joint is abnormal, the acute phase can produce pain due to synovial imbrication, and chronic disease can produce posterior joint traumatic arthritis and lumbago. This pain mostly occurs at 1.5 cm next to the spinous process, and there may be radiating pain to the ipsilateral hip or behind the thigh, which is easily confused with lumbar disc herniation. The radiating pain usually does not exceed the knee joint and is not accompanied by signs of nerve root damage such as sensation, muscle weakness and loss of reflexes. In cases where identification is difficult, 2% procaine 5 ml can be injected near the small articular eminence of the lesion, and if the symptoms disappear, lumbar disc herniation can be excluded. The fact that most of the small joint disorders are immediately relieved by manipulation is also an important differential point.