Low back pain (LBP) is a common clinical condition, and the treatment of LBP has changed dramatically in the last decade. Lower back pain is the leading cause of work incapacity in people younger than 55 years of age who are able to work. Lower back pain has many different etiologies. Many lower back pains cannot be diagnosed by medical history, physical examination findings, or diagnostic tests. Psychosocial and occupational risk factors often influence the diagnosis, making it difficult to explain in terms of organic pathology. Repeated bending and turning of the lower back increases the risk of low back pain and disc herniation. Smoking, obesity, may also be associated with the incidence of lower back pain. It has been found that the incidence of lumbar disc herniation is three times higher in smokers than in nonsmokers. The incidence of both low back pain and lumbar disc herniation is higher among smokers; lower back pain may also be a manifestation of psychological disorders. The normal morphology of the lumbar spine and the morphological changes after lumbar disc degeneration, the mechanism of nerve compression, the above figure is a schematic diagram (a) Clinical Presentation The clinical presentation of lumbar disc disease is mainly low back pain with unilateral or bilateral radiating pain in the buttocks and posterior thighs, aggravated by coughing or sneezing, positive straight leg raising test or weakened Achilles reflex. Reduced nerve root sensitivity and unilateral pain with or without significant muscle tension are suggestive of spinal origin disease. The most common causes of non-spinal origin low back pain are renal and vascular disease; cancer can also cause back pain with nocturnal resting pain, unexplained weight loss and fatigue. (ii) Imaging With the improvement of diagnostic and therapeutic tools, human beings are gradually recognizing that many lower back pains have clear organic causes that can be effectively treated. The rapid development of radiology, electromagnetic diagnosis and puncture techniques has increased the credibility of the diagnosis and produced more instructive treatment plans. X-rays can be used to diagnose lower back pain, with positive and lateral views of the lumbar spine usually being the primary examination and useful in the evaluation of the condition of the bones and ligaments. Lumbar spine imaging has the advantage of estimating nerve compression through dynamic visualization of hyperflexion and hyperextension views. CT is useful for evaluating fractures and spinal disorders or for preoperative planning and is an important option especially in patients with internal fixation.MR is the most accurate and sensitive for the diagnosis of subtle pathologies of the spine and is the gold standard for the diagnosis of lower back pain.SPECT bone scan is highly sensitive, poorly specific and provides good screening for degenerative and metastatic tumors, etc. SPECT is useful for localizing the source of the pain produced when there are apparently conflicting interpretations of multiple findings. Discography is an invasive and irritating test, and the patient’s pain response is the most important factor in determining the results. In some patients, discography may be the best way to investigate the source of pain, but there are too many subjective factors for its role to be overstated. （Treatment Options There are many ways to treat lower back pain, and there is a large body of literature on the subject, but few definitive reports. The difficulty in treatment is that there is too little correlation between the results of pathological studies and the patient’s presentation of pain and dysfunction, which requires the search for therapies that do not currently explain the clinical symptoms. These therapies are applicable to any form of pain, regardless of whether the pain mechanism is clear. 1. Bed Rest Lower back pain is often a self-limiting condition. More than 80% of patients with lower back pain experience improvement in the first two weeks. Bed rest is the most commonly used treatment for lower back pain, but it is controversial. The general consensus is that if bed rest is effective, the duration of bed rest should not exceed 2 days. 2.Medications Pain medications are often used in the treatment of lower back pain. Non-steroidal anti-inflammatory drugs are commonly used as anti-inflammatory and analgesic drugs, and the common adverse effects are gastrointestinal adverse reactions and nephrotoxicity. Selective COX-2 inhibitors are anti-inflammatory while reducing the risk of gastrointestinal side effects and others. Aminoacetophen and others are commonly used painkillers, but the side effects are significant and excessive doses can cause hepatotoxicity. Opioids are effective for symptom control, but long-term application can produce side effects such as drowsiness, vertigo, fatigue, nausea, dyspnea, and constipation. Short-acting narcotics are capable of causing insomnia. Long-acting opioids have less addictive properties and good drug resistance. All narcotic drugs should be used as sparingly as possible. Hormones have significant gastrointestinal risks, and long-term application has the potential to cause bone loss and increased infection, which can cause humeral head and femoral head necrosis and should be applied sensibly. Muscle relaxants can be used to treat acute lower back pain and are not indicated for long-term treatment. Muscle spasms around the spine are usually associated with acute lumbar sprains of various causes and are effective when this class of drugs is applied. Antidepressants have an important role, especially when accompanied by mood disorders. Their synergistic effect of antidepressant and analgesic is particularly useful in people whose lower back pain increases their depressed mood. Antiepileptic drugs (e.g., carbamazepine), are useful in the treatment of nerve pain, especially lower extremity pain. Their effectiveness in treating low back pain is still questioned. The drugs used to treat low back pain are quite individualized. Current opinion favors the use of nonsteroidal anti-inflammatory drugs for acute low back pain, starting generally with drugs that are not expensive or that are already effective for the patient. For acute lower back pain muscle relaxants may be applied for short-term treatment. For subacute or chronic lower back pain, antidepressants and other treatments are often added. Patients with chronic pain should avoid the application of muscle relaxants and opioids. Physical Therapy is a broad term that can be used to refer to stretching and strength exercises, low back pain schools, and other modalities. Physical therapy is more effective than medication alone; it is also more effective than massage for chronic pain. Specific lumbar hyperextension exercises have good results for patients with chronic low back pain. Suspension traction also has a role to play. They can play a role in reducing local muscle spasm and stabilizing the spine. Exactly what exercises are beneficial to the patient is not fully understood. In patients with atypical lower back pain, especially if accompanied by exercise and education, the ultimate goal in terms of symptom relief and improved function should include patient self-treatment of low back pain. Puncture therapy can be a complement to other therapies (e.g., transcutaneous puncture electrical nerve stimulation, Chinese electroacupuncture), applying electrotherapy to the low back. So far also some studies have shown that the effect of transcutaneous puncture electrical stimulation is not different from placebo. Traction is another method of physical therapy. The purpose of lumbar traction is to widen the intervertebral space, which widens the intervertebral foramen, creates space to reduce disc herniation, tenses the posterior longitudinal ligament to help reduce disc herniation, relaxes muscle spasm, and loosens nerve root adhesions. Prospective studies have shown that traction is not a significant treatment for low back pain, but does change its natural history. 4.Acupressure (Chiropractic Manipulation) Acupressure (such as massage) is the most common treatment for lower back pain. About 15% of people in the United States undergo acupressure treatment each year. Skargren et al. compared the cost and effectiveness of acupressure and physical therapy and found that acupressure was more effective for acute low back pain (low back pain within a week) and physical therapy was more effective for longer-term lower back pain. Many patients treated with acupressure have recurrent symptoms and repeated treatment. There is no evidence to support that long-term acupressure therapy can treat chronic low back pain, and the mechanism of acupressure therapy is not clear. 5.Lumbosacral Orthotic Device The purpose of using a lumbosacral support (such as a lumbar girth) is to provide stabilization. Vertebral fractures, vertebral slippage, and postoperative support are all indications for brace therapy. There is no literature to support the long-term application of lumbar supports for the treatment of lower back pain. Possible reasons for not using a brace are: poor patient compliance and the tendency to develop psychological dependence, leading to ineffective immobilization. There are controversial reports in the literature regarding the role of the brace in restricting movement.Axelsson et al. found no restrictive effect of the brace on sagittal displacement in patients wearing a thoracolumbosacral brace. The tight-fitting type of brace was able to reduce intervertebral motion at all segments by 30%. The brace did not show signs of altering the natural history of lower back pain. 6, Selective Injections Selective spinal closure helps to clearly diagnose the site of pain, and also increases the local anti-inflammatory effect of glucocorticoids, producing local anesthesia and therapeutic effects. Epidural closure is the most commonly used method of selective closure. Pain in the sacroiliac joint can be difficult to treat because of its diffuse innervation. Sacroiliac joint closure can provide some diagnostic and therapeutic benefit. schwarzer et al. concluded that when a patient has a history of sacroiliac pain, a specific site of pain in the lumbosacral region is identified, and intra-articular injections are given, only 30% of patients have significant symptom relief, suggesting that the sacroiliac joint may not be the cause of pain in most patients. The pain should be distinguished from sacroiliac arthritis due to ankylosing spondylitis. Intervertebral joints can be a source of low back pain, and local closure techniques have shown that intervertebral joints can cause low back pain. Patient history, physical examination, and imaging studies cannot be used alone to diagnose intervertebral joint-derived low back pain, and CT of the lumbar spine in asymptomatic individuals over 50 years of age often shows degenerative changes in the intervertebral joints. Extension pain, as opposed to flexion-aggravated pain, accompanied by radiographic evidence of arthropathy, suggests pain of arthralgiogenic origin. Branches of the medial branches of nerve roots innervate the lower two intervertebral joints (e.g., the medial branch nerves of lumbar 3 innervate the lumbar 3/4 and lumbar 4/5 intervertebral joints). If selective blockade of these nerves relieves lower back pain, it can help diagnose the intervertebral joint causing the pain. Correlating radiographic evidence with pain relief produced by intervertebral local anesthesia can be considered a diagnostic basis for intervertebral arthropathy. Sometimes medial branch nerve blocks are effective but brief, and pain relief can be more permanent with electrofrequency removal of the nerve root. This technique is performed by inserting a guide needle to locate the nerve that innervates the intervertebral joint and destroying the innervated nerve fibers with a frequency shot. Single-segment nerve root dissection is not very successful, and multi-segment nerve root dissection may have better results. 7. Intradiscal Electrothermal Therapy (IDET) has become popular in recent years for the treatment of discogenic lower back pain. The method involves placing a guide pin on the posterior side around the annulus fibrosus and heating the pin. Discography and MR examinations, often show high signal or internal tears in the posterior part of the annulus fibrosus, and pain is produced by stimulation of chemical and mechanical injury receptors. The exact mechanism of pain relief is unclear. Cadaveric studies have shown that spinal stability is not altered after electrothermal treatment of the intervertebral disc. The developers of the treatment believe that indications should include patients with persistent low back pain for more than 6 months who have been treated ineffectively with low back pain schooling, aggressive therapy, NSAID treatment, physical therapy, and progressive muscle strengthening exercises. Usually, corticosteroids are ineffective after local injections have been tried, physical examination shows a normal neurological examination, a negative straight leg raise test, no significant dural sac compression changes in the cauda equina on MRI, lumbar discography shows disc rupture, and the patient has significant lower back pain, which may be an appropriate patient selection or indication. Intervertebral disc electrotherapy has been criticized because the mechanism of this treatment is unknown and its efficacy lacks uniform evaluation and long-term follow-up studies. (iv) Review (Overview) The treatment of lower back pain is a challenge for the therapist. Treatment should be highly individualized based on symptoms and imaging findings, etc., with the patient being an active participant throughout the process in order to facilitate recovery and return to activity. The best option for non-surgical treatment is active treatment and intervention, coupled with patient education and rehabilitation guidance. Treatment is often a combination of various therapies. The treatment plan should be tailored to the patient’s specific situation. Early acute low back pain is often self-limiting in nature, with or without treatment, with significant symptom reduction within one to a few weeks of onset and possible improvement in the short term. Treatment includes medication: non-steroidal drugs, aminoacetophen, muscle relaxants, pain relievers (even anesthetics), etc.; short-term bed rest (up to 2 days); physical therapy such as: functional exercise, traction, acupuncture, etc.; chiropractic therapy: acupressure, massage, etc. For the treatment of severe lower back pain, a combination of NSAIDs and muscle relaxants is recommended, with no more than 2 days of bed rest. NSAIDs should be continued until the pain subsides; physical therapy should be started within a week. Treatment should include flexion and extension, strength exercises, and lower back stability exercises. Symptom relief should be applied only in the early stages to enable the patient to start exercises as early as possible. Long-term chronic lower back pain is more difficult to treat and the etiology is not easily defined. Treatment includes: medication: antidepressants; lumbar orthopedic braces such as lumbar braces; participation in low back pain schools; physical therapy; selective closure: epidural closure, nerve root medial branch closure, etc.; dorsal radiculectomy; and intradiscal electrothermal therapy. Education of the patient is part of the complete treatment process. Teaching patients how to protect themselves is one of the most effective ways to treat lower back pain.