When working in orthopedic clinics, I often encounter patients with radiology reports asking anxiously, “Doctor, the report says that the cervical (lumbar) disc is herniated, what should I do?” To answer this question, we must first clarify that “herniated disc” and “herniated disc” are two very different concepts, although there is only a word difference between the two. In fact, as we age, disc degeneration, bulging, protrusion is a phenomenon of normal degeneration of the human body, just like the wrinkles on the face, will become more and more obvious as we age. Studies have shown that one third of people aged 50-60 have bulging discs, while one fifth of people without pain symptoms (i.e., healthy people) have herniated discs. In asymptomatic people over 60 years of age, the incidence of bulging discs is 80% and the incidence of herniated discs is one-third, yet the vast majority of these people have no symptoms and therefore cannot be diagnosed with a “herniated disc”! This shows that even in normal people with no symptoms, disc herniation is a more common phenomenon as they age. Therefore, it is easy to misdiagnose a herniated disc by relying only on the imaging manifestations of the disc, ignoring the clinical symptoms of the patient and the causal relationship between the imaging manifestations and the symptoms. A “herniated disc” is a phenomenon seen through radiological imaging (X-rays, CT, MRI, etc.), and it is the radiologist’s responsibility to write down the pathological changes he sees without missing them, but the final diagnosis of whether the patient has a “herniated disc The final diagnosis of whether a patient has a “herniated disc” requires a comprehensive judgment by the orthopedic surgeon based on the patient’s medical history, physical examination, and various ancillary tests (including X-rays, CT, MRI, electromyography, etc.). So why can a herniated disc be asymptomatic? This is determined by the degree and direction of the herniated disc: if the herniated disc does not irritate and compress the nerves or cause spinal stenosis, then it is usually asymptomatic. Some patients have clinical symptoms and imaging tests show a herniated disc, but their clinical symptoms do not match the symptoms that a herniated disc may cause, and they are not diagnosed with “herniated disc”. Studies have found that “herniated discs” account for less than 10% of the symptomatic population. Many patients who are seen clinically have herniated discs on CT and MRI, but after history and physical examination, “disc herniation” is ruled out and appropriate conservative treatment is usually effective. For example, the following patient, an elderly female, 75 years old, had pain in her right lumbar region for 2 years, which was obvious when sitting and standing and walking, and was relieved by resting in bed. X-rays showed significant degeneration of the lumbar spine with significant osteophytes around the vertebrae; MRI showed degeneration of the discs in several segments and herniated discs in the lumbar 1-2, 3-4 and 4-5 vertebrae. However, physical examination revealed that the patient had no sciatic nerve compression symptoms and that the patient’s symptoms were caused by lumbar muscle dysfunction, which was completely relieved after suspension exercise therapy (SET) treatment. Thus, although there is only a word difference between “disc herniation” and “disc herniation”, the clinical significance is very different.