I. Bone spurs or osteophytes Bone spurs are a familiar term to many elderly patients, and I’m afraid you are suffering from them. Many elderly people are also running around to famous hospitals for treatment of cervical spurs, lumbar spurs, knee spurs or heel spurs, and some hospitals also have bone spur clinics and take various approaches to treat bone spurs. Now, without trying to be shallow, I would like to briefly explain the following views: Bone spurs often grow in areas where there is a large range of motion and a large force. For example, cervical spine, lumbar spine, knee, heel, etc. Not all bone spurs are clinically observed to produce symptoms. Many people with bone spurs do not always show symptoms. Bone spurs are the product of a compensatory mechanism in the body. When you get older, the pressure between the joints increases due to the decrease in the strength of the surrounding ligaments, muscles, and other soft tissues, and in order not to increase the pressure, the only way to increase the stress area of the joint is to increase the stress area and stabilize the joint. From a biomechanical point of view, different biomechanical effects produce different beginnings of bone spurs. For example, the direction of increasing pressure on the spur is the direction of increasing tension, such as the heel spur is due to the high tension of the metatarsal tendon membrane; the intercondylar spine of the knee joint is due to the tension of the “ten” ligament. The second is the increase in piezoelectric stress, according to the principle of piezoelectricity, the higher the pressure on the bone, the higher the local potential, which can make the osteoblasts active, stimulating the proliferation of osteocytes, high pressure sites will form bony protrusions, that is, bone spurs, obese middle-aged and elderly people commonly have bone spurs in the knee is this reason. Third, the bone spur caused by high stress. The pressure on the intervertebral disc increases and the annulus fibrosus bulges in all directions, involving both the posterior and anterior longitudinal ligaments, resulting in bone spurs or Luschka joint hyperplasia at the edge of the vertebral body. In terms of biomechanics, clinical manifestations, and imaging, bone spurs can be both physiological and pathological. Of course, physiological degeneration can also become pathological when it accumulates to a certain extent. Whether the pain is caused by a bone spur or not requires clinical differentiation. For example, there are several types of heel pain: heel fasciitis, subacromial bursitis, subacromial fat pad inflammation, heel osteochondritis, heel spur and so on. Therefore, the understanding of bone spurs should not be limited to bone spurs, and of course, the treatment should not focus only on bone spurs. The formation of bone spurs is the result of physiological and pathological changes rather than the initial cause of the disease. We suggest that biomechanical imbalance is the root cause of bone spur formation and soft tissue damage, and that restoring the biomechanical balance is the ideal treatment. We focus on the whole body, on the dynamic balance of the body, on the muscles, ligaments, fascia and other soft tissues, and on the fundamental way to relieve pain and disease. The cervical spine, thoracic spine and lumbar spine can all suffer from disc herniation, especially the cervical spine and lumbar spine, which occur with high frequency. The chances of herniation in the cervical and lumbar spine are not equal, with more chances of occurrence in the cervical 4-7, lumbar 4.5, and lumbar 5 sacral 1. The chance of thoracolumbar disc herniation is very small, but not absent, because the good site for herniation is often the site with large force and large range of motion, and the mobility of thoracic spine is very small, so the chance of occurrence is also small. It should be correctly understood that a herniated disc does not necessarily produce disc herniation. Especially in the elderly, the nucleus pulposus of the lesion has been absorbed, so there is no nucleus pulposus outflow or bulge, but only the rupture of the fibrous ring. A CT scan or MRI scan of a normal healthy person will also reveal a herniated disc. In addition, the size and extent of the herniation is not necessarily proportional to the severity of the symptoms. Nowadays, due to the popularity of CT and MRI, many patients have CT or MRI scans as soon as they have back and leg pain, and find that they have multiple herniated segments and are nervous, so they seek medical help everywhere, which is not conducive to the recovery of the disease. This is not conducive to recovery because the back and forth and mental tension can aggravate the pain stimulation. The diagnosis of a patient with disc herniation requires a comprehensive analysis of subjective symptoms, objective signs, clinical examination and imaging, and it is inappropriate to draw conclusions by considering only imaging. Another problem is that not all herniated discs in multiple segments will cause clinical symptoms. However, it is not easy to determine which segment is causing the symptoms and can only be inferred from symptoms, signs and ancillary examinations. The third issue is that herniated discs cannot be viewed in isolation. Small imbalances are self-repairing and compensating due to the interplay of biomechanical structures and compensations. Once the loss of compensation occurs, the dynamic balance is disrupted and the disc, upper and lower joint capsules, synapses, surrounding soft tissues, and vertebral body all become pathologically altered. Therefore, herniation is only one link in the chain of herniation and is not the only cause of symptoms. What is often referred to as a herniated disc includes two meanings: intradiscal symptoms on the one hand and extradiscal symptoms on the other. Spinal cord compression, with cauda equina compression, dural sac compression, nerve root canal stenosis, and distension are the causes of intradural symptoms; soft tissue lesions such as paravertebral muscles, joint capsule, ligaments, and fascia are all concomitant extradural lesions. In the current nucleus pulposus surgery, some surgeons only consider intradural lesions but do not recognize extradural lesions, resulting in poor long-term outcome of the surgery. A report from the United States concluded that there is a 53% failure rate for lumbar surgery. In a study conducted at Shanghai Long March Hospital, the removal of the vertebral plate during surgery resulted in an imbalance in biomechanical distribution, aggravating the release of stress on the small joints and contributing to their degeneration and imbalance in the functional units of the entire vertebral body. From the overall viewpoint of the spinal structure, herniated discs undergoing nucleus pulposus removal will also cause herniation due to the imbalance in biomechanical distribution and involvement of the functional units of the upper and lower vertebrae after surgery, and whether all herniations should be removed is clearly impossible. The fourth issue is that the whole human body structure is a whole and involves the whole body. For example, the skeletal structure of the human body is interrelated. A herniated disc produces protective muscle spasms due to pain thus leading to painful scoliosis of the spine. Scoliosis causes pelvic tilt, which in turn leads to imbalance in the force balance of the hip joint, which in turn leads to uneven forces on the knee and ankle. This series of dynamic imbalances leads to complex extravertebral symptoms of herniation, such as gluteus medius injury, pear-shaped muscle injury, lateral collateral ligament of the knee, peripatellar support band injury, infrapatellar fat pad inflammation, etc. Intricate, intertwined, internal and external, left and right are the characteristics of this type of disorder. Therefore, it is important to focus on the whole person in the treatment. We have successfully solved this problem by applying tension and compression, and we have also succeeded in treating soft tissue injuries with acupuncture and knife therapy to restore the inner dynamic balance.