In clinical practice, we often encounter patients with lumbar spine related with lower extremity symptoms (pain, numbness, abnormal sensation, etc.). A common cause in this group is the compression of the nerve roots of the lumbar spine. The nucleus pulposus and cartilage plate, especially the nucleus pulposus, have different degrees of degenerative changes, and under the action of external factors, the fibrous ring of the intervertebral disc ruptures, and the nucleus pulposus tissue protrudes (or comes out) from the place of rupture in the posterior or vertebral canal, resulting in stimulation or compression of the adjacent spinal nerve roots, thus producing a series of clinical symptoms such as lumbar pain, numbness and pain in one or both lower limbs. The incidence of lumbar disc herniation is highest in lumbar 4-5 and lumbar 5-sacral 1, accounting for about 95%. The basic etiology of lumbar disc herniation: 1. Degenerative changes of the lumbar intervertebral disc is the basic factor The degeneration of the nucleus pulposus is mainly manifested by the reduction of water content, and can cause small-scale pathological changes such as vertebral joint instability and loosening due to water loss; the degeneration of the fibrous ring is mainly manifested by the reduction of the degree of toughness. 2. injury Long-term repeated external forces cause minor damage, aggravating the degree of degeneration. This is mainly due to long-term incorrect activity posture. 3. Weakness of the disc’s own anatomical factors The intervertebral disc gradually lacks blood circulation and has poor repair ability after adulthood. On the basis of the above factors, some trigger factor that can lead to a sudden increase in the pressure on the disc may cause the less elastic nucleus pulposus to pass through the less tough fibrous ring, causing the nucleus pulposus to protrude. 4. Genetic factors Familial onset of lumbar disc herniation has been reported, with a low incidence in people of color. 5. Lumbosacral congenital anomalies include lumbar sacralization, sacral lumbarization, hemivertebral deformity, small joint deformity and asymmetry of articular protrusion. The above factors can cause changes in the stress on the lower lumbar spine, thus constituting an increase in intradiscal pressure and susceptibility to degeneration and injury. Lumbar spine osteophytes: The main cause of osteophytes is related to degenerative lesions of articular cartilage, and the osteophytes of the lumbar spine are due to the fact that after middle age, the lumbar spine osteophytes increase with age, and the physiological function of the tissue cells of the body gradually declines and ages, the degenerated intervertebral disc gradually loses water, the intervertebral space narrows, the fibrous ring relaxes and expands to the periphery, the vertebral body becomes unstable, and the fibrous ring tears outside the edge of the vertebral body, resulting in The protrusion of the nucleus pulposus will jack up the periosteum of the posterior longitudinal ligament and produce new bone underneath it, forming bone spurs or osteophytes. Lumbar spondylolisthesis is a chronic, progressive joint lesion, with lumbar three and four being the most common. If the sciatic nerve is compressed, it can cause sciatic neuritis, with severe numbness, burning pain, throbbing pain, string pain, and radiation to the entire lower extremity of the affected limb. Lumbar spine osteophytes are generally directly related to age, strain, trauma, incorrect posture, etc. 1, age factor human aging is an irresistible natural law, with the growth of age, the lumbar spine will inevitably degenerative changes due to sports wear, the vast majority of normal people over 60 years of age can be found in the lumbar spine spur formation, spinal space narrowing and other degenerative aging phenomenon. 2, strain factors The degeneration process of the lumbar spine, in addition to changes with age, also has a great relationship with lumbar strain, the lumbar spine is subjected to long-term repeated strain and over-activity and other undesirable factors, it is possible to accelerate the degeneration of the lumbar spine, so that the intervertebral disc protrusion, the formation of bone spurs and increasing; conversely, pay attention to lumbar rest and maintenance, you can slow down the rate of degeneration of the lumbar spine and the progress of bone spurs. 3, history of trauma trauma to the lumbar spine in adolescence is also an important external cause of lumbar spine osteophytes occurring after middle age. 4, incorrect posture Young patients with lumbar spine osteophytes are mainly associated with maintaining the same posture for a long time, while incorrect posture leads to sleeping on soft Simmons mattresses, and incorrect sleeping posture for a long time can also lead to lumbar spine osteophytes. The nerve root compression of the lumbar spine will generally compress the three nerves: the closed foraminal nerve, the femoral nerve, and the sciatic nerve: 1. The closed foraminal nerve comes from the lumbar 2, lumbar 3, and lumbar 4 nerve roots, and enters the lesser pelvis from the medial edge of the lumbaris major muscle, divided into two branches before and after, which enter the internal thigh muscle group, where the muscle branch innervates the external closed foraminal muscle and the internal thigh muscle group; the skin branch innervates the skin of the inner thigh. 2.Femoral nerve The femoral nerve is composed of lumbar 2, lumbar 3 and lumbar 4 nerve roots, which mainly innervates the quadriceps (medial femoral, middle femoral, rectus femoris, lateral femoral), suture, and iliac muscles on the anterior aspect of the thigh, and also innervates the sensation of the skin on the anterior aspect of the thigh and the medial aspect of the calf and foot. The sciatic nerve originates from the lumbar 4 and 5 nerve roots and sacral 1 nerve roots, exits the pelvis to the deep surface of the gluteus maximus through the inferior foramen of the pyriformis muscle, and descends to about 2 cm above the level of the popliteal fossa to divide into the tibial and peroneal nerves, which innervate all the muscles of the calf and foot and the skin sensation of the lateral calf and foot. Treatment of patients with lumbar nerve root compression – mechanical traction of the lumbar spine in the prone position There are many clinical treatment modalities for nerve root compression, and lumbar traction in the prone position is one of them. Fritz et al. in 2007 developed a clinical rule to help us determine which type of patients with lumbar nerve root compression can be treated with prone lumbar retraction. A 50% reduction in disability due to lumbar nerve root compression after 6 weeks of manual therapy, lumbar posterior extension exercises, and lumbar distraction in the prone position. The two physical tests are described below: 1. Peripheralization of symptoms by repeated lumbar posterior extension; 2. Positive Crossed SLR. The therapist assesses the change of symptoms in the lower extremity and considers it as Peripheralization if the symptoms move to the distal side. Positive Crossed SLR (Straight Leg Raise) The patient is placed in the supine position and the therapist performs a straight leg raise on the asymptomatic side of the lower extremity, if the symptoms of the symptomatic side of the lower extremity are reproduced, then the Crossed SLR is positive. Recommended treatment (patient treated for 6 weeks for a total of 12 treatments) includes the following: 1. Prone lumbar traction Patient in prone position with static traction for a maximum of 12 minutes with a traction weight of 40% to 60% of body weight. The traction was made only during the first two weeks of treatment. 2.Lumbar posterior extension exercises: repeated lumbar posterior extension in prone and standing positions, the degree of posterior extension is tolerated by the patient, emphasizing the achievement of maximum posterior extension range of motion without symptomatic peripheralization, 10 posterior extension exercises every 4 to 5 hours. 3. Unassisted treatment Posterior anterior lumbar arthrodesis at 3 or 4 levels (Maitland shock-type manipulation), with the therapist deciding on the vertebral segment to be treated based on assessment.