Non-surgical treatment options for lumbar disc herniation are numerous, ranging from simple bed rest to the use of expensive traction devices, all of which have reported exciting cure rates and, unfortunately, results that are largely unscientifically validated. Disc pathology can cause many different syndromes, and it is rarely possible to distinguish the specific pathological conditions associated with the various anatomical structures that respond to treatment. The simplest treatment for acute low back pain is rest, with 2 days of bed rest being more effective than long periods of bed rest. Biomechanical studies have proven that semi-Fowler’s position (i.e., bending the knees and flexing the hips in the lateral position) with a pillow between the legs can significantly relieve pressure on the intervertebral discs and nerve roots, and massage and cold compresses can relieve muscle spasm. Non-steroidal anti-inflammatory analgesics (NSAIDs) can reduce the pain and inflammatory response. Most acute episodes of low back pain respond well to these treatments. Once the pain has resolved, the patient should be encouraged to begin isometric muscle contraction exercises of the abdomen and lower extremities. Patients should be allowed to walk as long as they feel comfortable and sitting position is not advocated, especially sitting in a car. Training to maintain proper posture and position helps the patient return to his or her usual level of activity once the acute attack symptoms have disappeared or subsided, and this training can take many forms and can be performed individually or in groups. This type of back training instruction, now commonly referred to as “back school,” is very helpful in reducing missed work time during the first episode, but has little effect on reducing the rate of recurrence of symptoms or reducing missed work time during the recurrence period. However, back exercise instruction combined with physical therapy is certainly superior to comfort therapy. A study of patients with imaging-confirmed lumbar disc herniation with sciatica, but sacroiliac joint dysfunction without decreased muscle strength or sensation, found that 75% of patients improved in sciatica and low back pain, respectively, after aggressive physical therapy. There are many patients with neck and shoulder pain and lower back pain in the outpatient clinic, many of them are young people. In fact, neck and shoulder pain and lower back pain are the most common complaints of ambulatory workers or people who bend over for a long time (accountants, white-collar workers, students, IT industry, journalists, drivers, tailors, welders) in pain clinics, mostly caused by degenerative lumbar spine biomechanical changes formed by incorrect posture in work and life. The most incorrect postures are: sleeping on the sofa with the head on the armrest; curling up on the sofa to watch TV; looking down at the cell phone WeChat; playing games for too long; ambulating work with the computer too low, books too low, etc. The simplest way to exercise the lumbar back muscles include small swallow fly and five-point support method two, small swallow fly method: exercise when lying prone on the bed, go to the pillow, hands behind the back (very important), force chest up, through the neck muscles to make the head chest leave the bed, while the knee joint is straight, through the lumbar muscles so that the two thighs with also leave the bed, for 2 seconds, and then muscle relaxation rest for 2 seconds, on the completion of an exercise. Designed for 30 exercises as a cycle. So, (2 seconds + 2 seconds) * 30 = 120 seconds. Just 2 minutes to complete the day, is not it easy? If you want to increase the effect, you can perform 2 cycles per day. Five-point support method: lie on your back on the bed, go to the pillow and bend the knees, both elbows and back against the bed, the abdomen and hips up, relying on the head and shoulders (one point), both elbows (two points) and feet (two points) these five points to support the weight of the entire body for 3 to 5 seconds, and then relax the lumbar muscles, put down the hips to rest for 3 to 5 seconds for an exercise. Practice cycle with the small swallow flying method. Low back muscle exercise is the most “green” treatment method, through the body’s self-regulation, strength exercises and independent rehabilitation capabilities to regain the balance and health of the cervical and lumbar spine. If adhered to for a long time, will benefit for life. In terms of exercise, the most recommended is swimming breaststroke. There are various medications for the treatment of low back pain syndrome, and their efficacy varies. In the treatment of outpatients with chronic low back pain, strong narcotics and muscle relaxants are not used, because medication often causes addiction and depression. Short-term oral hormones can be as helpful as oral anti-inflammatory drugs. When aspirin is ineffective or intolerable, there are many nonsteroidal anti-inflammatory analgesics (NSAIDs) that are also effective. When patients are significantly depressed, the use of antidepressants such as amitriptyline may help reduce sleep disturbances and anxiety without exacerbating depression, in addition to reducing the amount of analgesics with amitriptyline. Patients with acute low back pain whose symptoms are relieved by passive hyperextension of the spine in the prone position will benefit from hyperextension exercises, but not flexion exercises. The improvement of symptoms with hyperextension is a sign that a good prognosis can be expected with conservative treatment. On the other hand, patients whose symptoms worsen with passive hyperextension may improve with flexion exercises. If the pain worsens during the exercise, the patient should not be forced to do further exercises, as this may prevent further disc herniation. Any exercises that aggravate pain should be discontinued. Lower extremity exercises can increase muscle strength and relieve back tension, but can also aggravate arthritis in the lower extremities, and the real benefit of these treatments is to improve the patient’s posture and mechanical function of the body, not to increase muscle strength. Regardless of the method used, pain is reduced in patients who complete all treatments. However, physical therapy appears to be more effective for male patients; for female patients, active back exercises are more effective. Manual laborers are more effective with physical therapy, and ambulatory workers are more effective with active back exercises. There are many ways to treat lower back pain. Some patients do better with transcutaneous electrical nerve stimulation (TENS), others do better with traction, which can be as light as 5 to 8 pounds of prone skin traction or as heavy as 100 pounds or more of inverted body traction. Some patients may benefit from back bracing and lumbar support. Ultrasound and heat therapy may also be used to treat low back pain. The scientific efficacy of many of these methods has not been proven. It should be added that all of these methods should only be used in patients with symptomatic herniated lumbar discs. Epidural hormone injection therapy Epidural injections of long-acting hormones in combination with anesthetics are 60-85% effective in the short-term for symptomatic treatment of discogenic and other properties of low back pain, while the long-term (6 months) effectiveness decreases to 30%-40%. Local therapeutic concentrations of hormones can be maintained for at least 3 weeks. Epidural hormone injections do not cure disc disease, but can provide relatively long periods of pain relief without the use of large amounts of analgesics in patients who choose conservative treatment methods. The following factors influence the effectiveness of surgical and epidural injection therapy, including low literacy level, smoking, unemployment, persistent pain symptoms, sleep disturbances, non-neurogenic lesions, longer duration of pain, interference with recreational activities, and extreme scores on psychological test scores. Complications of this approach are generally rare when performed by experienced physicians, with the most common problem being failure to inject hormones into the epidural space, which has a 25% incidence. Puncture under fluoroscopy significantly reduces the incidence of this error. Another technical problem is the injection of intra-dural and resulting spinal anesthesia. Other reported complications include temporary hypotension, dysuria, severe sensory abnormalities, angina pectoris, headache, and temporary hyperadrenocorticism. Retinal hemorrhage has occurred in several patients with chronic low back pain who had epidural hormone injections, so this method should be considered carefully in patients with a propensity for hemorrhage and in those with only one eye. Some patients have developed facial flushing and generalized erythema after epidural hormone injections. The most serious complication is bacterial meningitis. The overall complication rate is approximately 5% in the majority of reported cases, and the majority are temporary. Epidural injections are contraindicated in the following cases: infections, neurological diseases such as multiple spinal sclerosis, hemorrhagic or bleeding bodies, cauda equina syndrome, and acute progressive neurological dysfunction. Rapid and large injections of hormones or high doses of hormones can increase the incidence of complications. The exact effects of hormone injection into the dura are not known, and this method is limited to application within the lower lumbar spine. We prefer to forgo epidural injection if there is blood or cerebrospinal fluid in the puncture needle retrieval. It is recommended that this operation be done in a room with resuscitation and monitoring equipment. This method can be used in outpatients, but the patient must be prepared for several hours of recovery time. Methylprednisolone (Depo-Medrol) is a commonly used hormone injection in doses of 80-120 mg, and anesthetic drugs are available as lidocaine, bupivacaine, or procaine. The injection regimen is every 7-10 days for a total of three injections. This ensures at least one accurate injection into the epidural space and reduces the amount of drug administered in a single session.