Lumbar muscle strain is generally considered to be pain in the lower back caused by overexertion of the lumbar muscles, and imaging often reveals no abnormalities. Most true lumbar strains recover within 1 week, a few can drag on for 3 months, and those that last longer than 3 months are called chronic lumbar strains. Most of the lumbar muscle strain that is not cured for a long time is misdiagnosed, and the real lesions are often the following: 1. Discogenic lumbago: that is, lumbago caused by intervertebral disc degeneration. It is manifested as pain in the middle of the lower back, with vague localization, aggravated by prolonged sitting and alleviated by bed rest. Magnetic resonance examination can confirm the diagnosis. Treatment methods include ozone ablation, radiofrequency ablation, discoscopic decompression. Artificial disc replacement, etc. 2, posterior branch of spinal nerve syndrome: the posterior branch of spinal nerve is caused by fiber and tendon tissue compression. It is aggravated when the lumbar area is moved in a certain direction, and there are pressure pain points next to the vertebrae. The lumbar pain may spread to the lower extremities, but does not exceed the knee joint. Zhujiang Hospital in Guangzhou has conducted research on this condition for nearly 30 years. The diagnostic and therapeutic methods created have won the military and national science and technology progress awards. Typical case: 45-year-old female with back pain with left lower limb pain for 10 years, CT reported lumbar disc herniation (30% of normal people have disc herniation on CT). The inexperienced doctor had planned to perform internal fixation surgery with a total cost of 50,000-70,000 and required 2 weeks of hospitalization. He was referred to our hospital by a patient, and was diagnosed with posterior spinal nerve syndrome after examination revealed small synovial pressure pain, with radiated pain over the knee, and was treated with needle knife release, which completely disappeared the symptoms, costing 10 minutes and 60 yuan. No recurrence at 5 years follow-up. 3, lumbar isthmus crack: lumbar isthmus discontinuity caused by the affected vertebral joint synapse pressure pain. x-ray double oblique film can be found “dog neck fracture sign” and confirmed the diagnosis. The treatment method is mainly posterior fusion internal fixation surgery. 4, osteoporosis: lower back pain, aggravated by activity, lumbar spine extensive pressure pain, doctor’s examination and bone densitometry examination can confirm the diagnosis. Three types of basic drugs are most often used: (1) osteoclast inhibitors such as diphosphonates Fosamax tablets, solid state tablets (2) calcium preparations such as calcium gluconate, etc. (3) Vitamin D class, such as Alfadex three, etc. There are also estrogens, calcitonin, strontium ranelate, bone peptides, bone gourd extract and Chinese medicinal preparations, all of which have their indications and should be used reasonably under the guidance of a physician. Elderly patients with combined compression fractures can be treated with percutaneous posterior protrusion molding or vertebral body molding, which is less invasive and more effective. 5.Lumbago of visceral origin: nephritis, hydronephrosis, pelvic inflammatory disease, adnexitis and other visceral lesions can cause lumbar involvement pain, mostly not related to body position, mostly accompanied by abnormal manifestations of related organs, visceral ultrasound, MR, CT examination can confirm the diagnosis. 6.Ankylosing spondylitis and other autoimmune diseases: mostly pain at night and pain in the morning. Blood test erythrocyte sedimentation rate, HlAB27 antibodies, ultrasensitive C-reactive protein and other indicators are often elevated. At present, mainly rely on immunosuppressive drugs for treatment. 7, spinal tumors: malignant tumors mostly have progressive aggravation, weight loss and other wasting manifestations. Nocturnal pain is obvious. MR, CT and PET can be used to detect these tumors. In addition to chemoradiotherapy, interventional therapy is also gradually increasing in treatment. 8, spinal infections: general bacterial infections are often accompanied by fever and chills, the onset of fierce; tuberculosis, brucellosis and other atopic infections often show a chronic process. Laboratory tests, MR, CT, lesion biopsy, and culture can confirm the diagnosis. Surgical removal of the lesion and antibiotics are often required.