A definitive diagnosis of most lumbar disc herniations can be made based on the history, symptoms and signs, and imaging (CT or MRI) examinations. Here is how to differentially diagnose lumbar disc herniation. I. Acute lumbar sprain In addition to a history of acute trauma and severe lumbar pain, there is occasional pulling pain in the buttocks and lower limbs, but there are few positive signs for this disease, no pressure pain along the sciatic nerve distribution area, no limb sensory abnormalities, and no abnormal tendon reflexes. The straight leg raise and strengthening test were negative. Chronic lumbar muscle strain has a long course, light symptoms, extensive pressure points, lumbar pain and exertion, rest, wind, cold and humidity are closely related, there may be sacrospinous muscle plate stiffness and lower limb reflex pain, easily cured by rest, physical therapy, massage. Pear-shaped muscle syndrome is caused by excessive abduction, external rotation or internal rotation of the lower limbs, injuring the pear-shaped muscle and involving the sciatic nerve. The pain is mainly in the buttocks and lower extremities. The local pressure pain of the pear-shaped muscle is obvious on examination, and the pain is obvious before the straight leg raise test at 60°, but decreases after exceeding 60°, and the pear-shaped muscle tension test is positive. The pain is not affected by the change of position, the pressure points are widespread, the straight leg raising test is negative, the tendon reflexes are not abnormal. x-ray examination shows narrowing of the vertebral space, and there is obvious osteophytes on the anterior and posterior edges of the vertebral body.