With changes in work and rest patterns (especially the popularity of computers), lumbar pain is becoming an increasingly common disease. The more common disease is lumbar disc herniation, but not all lumbar pain or leg pain is lumbar herniation, now the common lumbar leg pain disease points are summarized as follows: 1, lumbar disc herniation on the lumbar leg pain is the most common main symptoms, mostly seen in young adults. The onset of acute, patients often have a history of lumbar sprain, serious back pain after the injury, the lighter can still be tolerated, the heavier bedridden, turning over extremely difficult. Symptoms can be seen in bed after the pain is reduced. The following lumbar disc herniations are common: lumbar 4, lumbar 5 and sacral 1 nerve root compression and pain in the sciatic nerve innervation area, manifesting as numbness or radiating pain along the affected hip, posterior thigh, lateral calf and lateral foot. When the nucleus pulposus protrudes large or central, it may cause pain in both lower limbs. In severe cases, paralysis of the saddle area, difficulty in urination and defecation, and paralysis of both feet may occur. Clinical examination shows that: lumbar deformity, lumbar disc herniation first has the physiological anterior curvature of the lumbar segment of the spine reduced or disappeared, and even becomes reverse posterior curvature. As the nucleus pulposus protrudes backward, the passive forward bending of the lumbar region can relieve the compression of the nerve roots. Lateral curvature of the lumbar spine occurs later, mostly in cases where the lumbar pain lasts for a long time. When the herniated disc compresses the nerve roots in the lower part of the spine (axillary type), the spine bends to the affected side; when the herniated disc compresses the nerve roots in the upper part of the spine (supra-shoulder type), the spine bends to the healthy side. The functional activity of the lumbar spine is limited; paravertebral pressure and percussion pain with radiating pain; positive straight leg raise test and strengthening test: positive straight leg raise test on the healthy side indicates a large central disc protrusion or axillary protrusion, and negative for supra-shoulder type. A positive femoral nerve pull test indicates a herniated disc in the upper lumbar region. Positive flexion test and jugular vein compression test, change of tendon reflex: if the nerve root is severely compressed or compressed for too long, the corresponding tendon reflex disappears. Skin sensory abnormalities, mainly hypoesthesia or numbness of the skin in the area innervated by the corresponding nerve. If the central herniation compresses the cauda equina nerve, numbness in the saddle area and dysfunction of the bladder and anal sphincter may occur. If the upper lumbar disc is herniated, the femoral nerve is involved and the quadriceps muscle is weakened and the muscle is atrophied; when the sciatic nerve is involved, the gastrocnemius muscle tone is weakened, the thumb extensor muscle is weakened, the dorsal extensor muscle group of the foot is atrophied if the disease is prolonged, and the anterior tibial ridge is herniated. x-ray examination, MRI, CT examination, etc. can see the lumbar disc herniation changes, and electromyography examination can see the nerve root damage. 2, thoracic, lumbar vertebral tuberculosis This disease is mostly secondary lesions, the causative factor is Mycobacterium tuberculosis. The patient may have a previous history of tuberculosis or exposure to tuberculosis. The lower thoracic segment of the thoracic or lumbar vertebral tuberculosis presents with symptoms such as lumbar pain or numbness very similar to lumbar disc herniation, but the duration of the disease is long, and some of the pain sites are not consistent with the lesion site, often complaining of lumbar pain, which is often easy to cause missed diagnosis. Patients often have systemic symptoms, such as low fever, night sweats, wasting and weakness. Local pressure pain is not obvious, but percussion can cause local pain. The posture is abnormal and activity is limited. When standing or walking, try to tilt the head and trunk back to reduce the pressure of the weight on the affected vertebrae. Try to bend the knees and hips when picking up things from the ground, avoid bending over, and hold the front of the thighs with your hands when standing up (positive pick-up sign). Cold abscesses may sometimes be palpable in the lower abdomen. Laboratory tests accelerate blood sedimentation, positive for tuberculosis antibodies, X-ray radiographs show a blurred, narrowing of the intervertebral space, the relative edge of the vertebral body with bone destruction, the central type can have dead bone, cavity formation, surrounding osteoporosis. 3.Intravertebral tumor Intravertebral tumor is a collective term for primary tumors and metastatic tumors growing in the spinal cord itself and in the tissue structures adjacent to the spinal cord (such as spinal nerve roots, dura mater, adipose tissue, etc.). It is a completely different disease from lumbar disc herniation. When intravertebral tumor compresses the spinal cord and nerve roots, it may cause radicular pain similar to lumbar disc herniation, and symptoms such as back and leg pain or numbness may occur. However, one of the typical symptoms of intravertebral tumor is that the pain or sensory abnormality is persistent and progressive, not relieved by bed rest, while the lumbar pain caused by lumbar disc herniation is persistent, relieved by lying down, and aggravated by standing activities. In terms of physical signs, the paravertebral and hip pressure pain of intravertebral tumor is not obvious, the straight leg raise test and straight leg raise strengthening test are not typical, and the sensory-motor reflex disorder is often not limited to one nerve root innervation area. Intravertebral tumors above lumbar 1 may show spinal cord compression with positive pathological reflexes, and cauda equina tumors may have multiple roots or cauda equina nerve compression signs. In lumbar disc herniation, there is pressure pain at the herniated space and radiation to the lower extremities, and the compression of a single nerve root causes motor, sensory and reflex impairment. For patients with lumbar disc herniation who have neurological changes such as limb sensation, motor disorders or reflex changes, and who do not have significant effect or worsen after systematic conservative treatment, the possibility of intravertebral tumor should be considered and further examination is needed. In terms of imaging examination, there are bony changes in X-ray plain film, such as scoliosis, widening of the spinal arch spacing and enlargement of the intervertebral foramen, etc. However, these changes can only occur in huge tumors, and there is a greater possibility of misdiagnosis of spinal cord tumors due to different levels of examination in CT scan. Some intravertebral tumors, especially lower lumbar tumors, are difficult to distinguish from lumbar disc herniation in terms of symptoms or physical signs. Therefore, myelogram or MRI is the best examination method to determine the approximate lesion site according to symptoms and clinical examination. After the diagnosis is clear, surgery is the main treatment for intravertebral tumors, and manual therapy is prohibited. 4, ankylosing spondylitis Ankylosing spondylitis is a chronic inflammatory disease that mainly involves the spine, the medial skeleton and large joints of the extremities, and is characterized by fibrosis of the intervertebral disc ring and nearby connective tissue, ossification and joint ankylosis. Because of the slow development of the lesion, early diagnosis of ankylosing spondylitis is difficult, but early diagnosis and treatment is the key to reducing the disability rate of the disease. The main symptoms are low back pain and osteoarthritic lesions. The lesions begin in the sacroiliac joint and gradually involve the lumbar, thoracic and cervical vertebrae, resulting in blurring of the intervertebral joint space, loss of fusion, osteoporosis and destruction of the vertebral body, ossification of the ligaments, and even hunchback fixation and loss of work capacity. In addition to lumbar pain, it can be accompanied by stiffness and pain in the thoracic back and neck, and joint pain in the lower limbs, with a feeling of stiffness after prolonged rest, which is reduced or disappears after activity; lumbar intervertebral disc herniation is relatively acute, often with a history of trauma, mostly in young adults, lumbar pain is accompanied by pain and numbness in the sciatic nerve distribution area, and the pain increases with activity, and the joints of the lower limbs are not swollen. The physical examination of ankylosing spondylolisthesis is not obvious or only mild pressure pain in the soft tissues of the lumbar region, and a variety of signs are negative, while the “4” sign test may be positive. In lumbar disc herniation, there is often obvious deep pressure pain next to the spinous process of the lower back, or radiating pain in the lower limbs, and neurological examinations such as straight leg raising test and strengthening test, thumb dorsiflexion test and neck flexion test are positive. Physical and laboratory examinations: X-ray examination shows blurred or narrowed sacroiliac joints in ankylosing spondylitis, elevated blood sedimentation when symptoms are obvious, and rheumatoid factor test is often positive, while there are no such changes in lumbar disc herniation. The effect of treatment is different: the symptoms and signs of lumbar disc herniation often improve significantly after systematic conservative treatment such as traction, manipulation and local closure, while the effect of ankylosing spondylitis is not obvious after the above treatment. The diagnosis of ankylosing spondylitis is easier when there are obvious lumbar or back and neck and lower limb joint ankylosis in the middle and late stages, and the X-ray is a bamboo-like change in the lumbar spine. 5, ischemic necrosis of femoral head Early symptoms of aseptic ischemic necrosis of the femoral head are pain in the front, lateral and hip of the hip joint, aggravated by activity, and some patients have pain in the front inner thigh and the front inner knee joint, similar to lumbar disc herniation. However, the lumbar symptoms and signs of femoral head ischemic necrosis were not obvious, and the neurological examination such as straight leg raising test and strengthening test, thumb dorsiflexion test and flexion neck test were negative. The diagnosis can be confirmed by further X-ray and MRI examination of both hip joints. Through careful consultation and physical examination, the differential diagnosis between aseptic ischemic necrosis of the femoral head and lumbar disc herniation is easy. 6.Sacroiliac joint dislocation Sacroiliac joint dislocation is a lumbosacral osteoarthritic injury that commonly causes sciatica in clinical practice. Both sacroiliac joint dislocation and inflammatory reaction can pull or stimulate sciatic nerve stem and pear-shaped muscle and cause pain or numbness in the affected limb, which is very similar to the symptoms of lumbar disc herniation, but there are still some differences. The symptoms of sacroiliac joint dislocation are common, sometimes light and sometimes heavy, the pain site is variable, the boundary is blurred, and the affected limb feels shortened. The symptoms of lumbar disc herniation are more stable and the area of pain and numbness is fixed. In terms of signs: when the sacroiliac joint is misaligned, the lumbar spine scoliosis deformity protrudes to the healthy side, the pressure point is in the sacroiliac joint, and the “4” sign test is positive. In lumbar disc herniation, the lumbar scoliosis is more convex to the affected side, the pressure point is next to the spinous process of the lumbar spine, the spinous process is skewed or the upper and lower spinous gaps are not equal. x-ray and CT, MRI, etc. can help differentiate. 7, lumbar spine slippage and spinal stenosis Lumbar spine isthmus discontinuity and slippage is one of the common causes of lumbar leg pain. In patients with simple lumbar isthmus discontinuity and spondylolisthesis, the main symptom is lumbar pain, which may occasionally spread to the buttocks or thighs, aggravated by exertion and relieved by bed rest, very similar to lumbar disc herniation, but without signs of nerve damage. In combination with spinal stenosis, in addition to lumbar pain, it is often accompanied by pain, numbness or weakness in one or both lower limbs, with intermittent claudication, and nerve root or occasionally cauda equina damage of different degrees. X-ray and MRI examination can clarify the diagnosis. 8, lumbar spinal stenosis Lumbar spinal stenosis is mostly seen in middle-aged and elderly people over 40 years old, with a slow onset, different from the central disc herniation which is often sudden. Its main symptoms are long-term lumbago, leg pain, intermittent claudication, and lumbago is only manifested as lower back and sacral pain, which is aggravated when standing and walking, and alleviated when squatting, sitting and hip flexion in lateral position; leg pain is mainly caused by sacral nerve root compression, which often involves both sides, and is not aggravated when coughing, but aggravated when walking, or accompanied by abnormal sensation and motor weakness of lower limbs. The lumbar disc herniation has no intermittent claudication, and the symptoms are aggravated by walking, standing and coughing, and the straight leg raise test and strengthening test are positive. x-ray and MRI examination can help to differentiate the lumbar spine and intravertebral canal. 9, the third lumbar transverse process syndrome, pear-shaped muscle injury syndrome The third lumbar transverse process syndrome and pear-shaped muscle injury syndrome is also one of the causes of lumbar numbness and leg pain. Third lumbar transverse process syndrome and pear-shaped muscle injury syndrome, there are obvious pressure points in the third lumbar transverse process or pear-shaped muscle site, early local soft tissue swelling, late local muscle relaxation or varying degrees of atrophy, local spastic nodules or striae can be palpated, third lumbar transverse process syndrome lower extremity radiating pain generally does not exceed the nest; pear-shaped muscle injury in straight leg elevation 30 ° ~ 60 ° can cause increased pain. The pain is relieved when it exceeds 60°. In lumbar disc herniation, the pressure point is next to the spinous process of the lower lumbar vertebrae, and there may be radiating pain in the lower extremities, and the neurological examination of the lower extremities is mostly negative in the former and positive in the latter. Since the superior gluteal cutaneous nerve originates from the lateral branch of thoracic 12 to lumbar 3 and crosses the iliac spine through the back extensor muscle to the buttocks, the treatment of the third lumbar transverse herniation syndrome and injury to the pear-shaped muscle can be achieved with immediate effect by dividing and regulating the tendons of the superior gluteal cutaneous nerve and pear-shaped muscle pressure points.