Step 1 Ask for diagnosis; 1) Where exactly is the discomfort and the duration of the disease (2) The nature of the pain, whether it is localized or radiating, the area of radiation, and whether there are any other concomitant symptoms The area of radiation: ① Posterior thigh to the N fossa – L3/L4 segment ② Posterior lateral thigh – L3/L4 segment ③ Radiation to the calf L5/S1 segment ④ Simple lower back to the gluteal transverse line L3/L4 segment ③ Radiating to the calf —-L5/S1 segment ④ Simply lower back hip to the transverse gluteal line –L5/S1 supraspinatus, interspinous, sacroiliac joint, iliac crest lip, pyriformis, gluteus maximus, gluteus minimus (3) The causes of morbidity, including the working environment, living habits, geographical characteristics Geographical characteristics: ① people in the south – the muscles are more flaccid, the operation amplitude should be small (2) Northern people – the muscles are more compact, the operation amplitude can be large (4) Any history of trauma, malignant diseases, serious skin diseases, etc. Overall assessment 【Step 2: Examination】 (1) Walking posture Whether there is a slanting neck, whether the two shoulders are horizontal, whether the spine is scoliotic and retrograde, whether there is a limp in gait, and whether the toe of the foot is facing forward (2) Observation of the face Much pain, Emaciated, anxious face. (3) sitting posture, see whether the spine has scoliosis, retroversion, depression, whether the muscles on both sides of the tense contracture [Step 3: Specialized examination] (a) standing position examination, ask the patient to do forward and backward movements: ① forward and backward symptoms aggravated – extra-vertebral canal lesions ② backward symptoms aggravated – intra-vertebral canal lesions. -(b) Sitting position examination: knock on the joint capsule between the transverse processes with an imaginary fist to see if there is any pain and radiating pain, and pay attention to the elderly and patients with severe radiating pain to be gentle. (C) Supine position examination 1. Comparison of the morphology and length of both lower limbs (1) Morphological comparison The patient’s both lower limbs are naturally straightened, and the operator stands in front of the patient’s heel. The operator holds the patient’s ankle joints with both hands and lifts them up 30~40cm, then releases them and lets them fall down naturally, and observes the morphology of the feet after landing on the bed. Normal: ↑ ⊙ ↑ – the feet are slightly abducted upward ② Adduction: J ⊙ I or J ⊙ ↑ – suggests spasticity and tightness of the anterior medial adductor muscle of the thigh ③ Adduction: I ⊙ J or I ⊙ ↑ – suggests spasticity and tightness of the posterior lateral thigh adductor muscle. -suggests spasm and tightness of the posterior lateral adductor of the thigh (2) Length Comparison The operator palms both hands underneath the patient’s ankle joint and holds both thumbs in front of the ankle joint. The operator squats down while the patient’s ankle is pulled downward to straighten the heel and compare the length of the two heels. ①Normal: equal length ②Abnormal: unequal length – suggesting displacement and tilt of the lumbosacral segment and pelvis 2, straight leg raising test ① 10 ~ 30 ° began to worsen the radiating pain – positive sign ② 40 ~ 60 ° began to worsen the radiating pain –Weak positive signs ③ 70 ~ 90 ° began to worsen the radioactive pain – negative signs 3, “4” test, ankle joint on the opposite knee, the outside of the knee of a normal person can be close to the bed. The outside of the normal knee can be close to the bed surface, if it can’t be contacted or can barely be contacted but the hip is uncomfortable – suggests that the femoral adductor group is tight and there is a problem with the hip joint. 4, the reverse “4” word test, ankle joint on the opposite knee, the operator one hand on the patient’s shoulder, one hand will knee to the opposite side of the pressure, such as hip and lower back pull discomfort – suggests the sacroiliac joint, iliac crest lip, gluteus medius and pyriformis have problems (d), Prone position examination 1, thoracic and abdominal pillow test (1) 30cm high pillow under the chest, hands naturally placed on both sides, so that the lumbar segment downward depression – such as lumbar pain intensification, suggesting intravertebral canal lesions, true protrusion, mostly accompanied by radiological symptoms (mechanism): thoracic cushion pillows, lumbar segment of the vertebral canal in the interstitial space narrowing, yellow ligament accumulation, overlap of the small joints, the The small joints overlap, squeezing the small joint capsule and the nerve root, causing the nerve root to collide with the protrusion and the dural sac, resulting in distal neuroradiation symptoms (2) 30cm high pillow under the abdomen, with both hands naturally placed on both sides, so that the lumbar segments protrude backward – such as increased lumbar pain, suggesting extra-vertebral canal lesions, pseudo-protrusion, and not accompanied by radial symptoms (Mechanism): After the thoracic pad is placed with pillows, the Lumbar segment of the intervertebral space increased, the muscles of the lumbar back are pulled taut and soreness and discomfort, less neuroradiation symptoms 2, lower abdomen pillow check abdomen pad 15cm pillow, chest pad thin pillow, so that the lumbar fully backward bulging (1) look at ① Observe the thoracic lumbosacral spinal column of the general contour of the thoracic lumbar-sacral region, to see if there is a sideways curvature, concave-convex, reverse bowing and other curvature changes ② Observe the spinal column muscles on both sides of the taut, bulging, clear edge of the striated a ② Observe whether the muscles on both sides of the spine are taut, bulging, and clearly edged. a, bulging on both sides, concave in the middle. b, bulging on one side, concave on the other. c, bulging in the thoracolumbar segment, concave in the lumbosacral segment. d, obvious accumulation of the muscles in the lumbosacral segment, or overly flat. ③ Observe whether the highest point of the iliac crests on both sides are at a horizontal line. There is no atrophy or contracture. Clinically more high on one side and low on the other – suggests: lumbosacral iliac, pelvic problems (2) palpation ① check the spine for scoliosis – the middle and index fingers are placed separately on both sides of the thoracic vertebral spinous processes, from top to bottom, from light to heavy sliding feel to the lumbosacral region ② check the spinous processes for lateral curvature –thumb on the upper segment of the thoracic spine, against the spinous process on one side slowly sliding down, and then the opposite side. ③ false fist percussion to find the pain area a, the spinous process line – L5/S1 segment, L5/L4 segment, L4/L3 segment, to see the spinous process, interspinous, supraspinatus have no pain, clinical L5/S1 segment is common b, both sides of the transverse process – L5/S1 transverse process department, L5/ L4 transverse process, L4/L3 transverse process, to see if the pain is localized or radiating ④ Thumb pressure to find pain points a. Press the top of the spinous process and up and down b. Press the joint capsule 2 cm adjacent to the spinous process c. Press the tip of the transverse process of L3, L4, L5, and S1 d. Press lumbosacral and sacroiliac joints, iliac crest labrum e. Press the pyriformis muscle and its exit, the beginning and end of the gluteus medius muscle, the distribution area of the gluteus superior nerve, the ilioiliac tibial bundle, sciatic tuberosity, and the outlet of the transverse gluteal stripe to see if there is deep pressure and radiating pain and contracture points. If the thumb does not find a positive point, the fingertip can be used to look for it with a little force. ⑤ Look at the degree of muscle densification. a. Densification – indicates that there is a problem in the superficial and middle layers, and the operation should be performed with fan loosening in the middle layer. b. Loosening – prohibit large-scale operation, and prohibit the use of dialing needles. Lumbar intervertebral disc herniation identification] 1, true herniation (intravertebral canal lesion) nerve root compression, the location of the compression: the inner and outer mouth of the spinal canal. Symptoms: distal radiating severe pain 2, false herniation (extravertebral canal lesion) (1) nerve trunk compression: location of compression: pyriformis outlet, gluteus medius, gluteus minimus, sacroiliac joints, iliac crest labrum compression of the sciatic nerve trunk. Symptoms: radiating pain area second only to radicular (2) Plexus compression: location of compression: the outlet of the gluteal transverse stripe compresses the posterior cutaneous nerve of the femur, the medial cutaneous nerve of the gastrocnemius muscle in the medial side of the N fossa compresses the common peroneal nerve at the posterior-lateral 2 cm of the fibular tubercle. Symptoms: associated radiographic regional symptoms