During the morning clinic, a sad-looking old man in his 70s came in, followed by his daughter, carrying a paper bag with the results of a CT and MRI of his lumbar spine. ”Doctor, my father’s back and leg pain has been going on for 5 years. This is the result of his visit to the county people’s hospital ‘photo’ the day before yesterday, the diagnosis is lumbar disc herniation. The doctor there told my dad to have surgery, but he is so old, which can withstand the torment of surgery. Can you see if there is another way to treat his disease? We don’t want to have surgery.” The old man’s daughter said. When I heard this, I realized that this was another case that had entered the misconception that “low back pain + disc herniation image changes = lumbar disc herniation”. I suggested the old man to have an infrared thermographic examination. The results of the examination revealed that the old man’s back and leg pain was caused by soft tissue injury, not by a herniated disc. His lumbar disc herniation was physiological, and he did not suffer from lumbar disc herniation. Therefore, the elderly do not need surgical treatment, even though they may still have pain after surgery. Low back pain is a very common clinical condition with many causes, and lumbar disc herniation is one of the causes. Lumbar disc herniation is an imaging change with physiological and pathological causes; lumbar disc herniation belongs to the pathological category, which refers to a series of syndromes of back and leg pain caused by a herniated disc as the pathological basis. These two concepts do not seem to be difficult to distinguish theoretically, however, in clinical practice, it is not uncommon for patients to be easily diagnosed with disc herniation when they have symptoms of low back and leg pain and CT suggests a herniated or bulging lumbar disc. Therefore, it is not uncommon for those with lumbar pain accompanied by lumbar disc herniation to be misdiagnosed as lumbar disc herniation and then diagnosed as femoral head necrosis, sacroiliac joint injury, posterior lumbar nerve branch pain, gluteus fasciitis, etc. after prolonged ineffective treatment. In fact, the causes of back and leg pain are very complex, and only a few have a clear causal relationship with disc herniation, most of them are other causes, which require careful physical examination and further examination by doctors. Even if it is a clear disc herniation, only a few patients have surgical indications that must be treated surgically, and most patients can be clinically cured by non-surgical treatments such as small acupuncture, silver needle, and nerve block. Therefore, in the diagnosis of lumbar disc herniation, the mechanical thinking pattern of “back and leg pain + disc herniation image change: lumbar disc herniation” must be eliminated, and in the treatment out of “back and leg pain + disc herniation image change: lumbar disc herniation and must be operated. In treatment, we should get out of the misunderstanding of “low back pain + disc herniation image change: lumbar disc herniation and must be operated. At present, infrared thermography used clinically for the diagnosis of low back and leg pain is of great benefit to the diagnosis. A large number of studies and practices at home and abroad show that patients with low back and leg disease use CT and MRI examinations to understand the bone structure, and use infrared thermography to understand the soft tissue functional state situation, and combine the two images to analyze, it can greatly reduce and avoid the blindness of diagnosis and treatment, and increase the objectivity; it also reduces unnecessary pain for patients in treatment.