Lumbar Disc Herniation

A herniated lumbar disc presses on or irritates a nerve root, producing pain that radiates into the leg, sometimes with numbness or weakness. The majority improve over weeks to months without an operation, and imaging findings correlate poorly with symptoms — many people without any back pain have disc bulges on MRI.

This is why treatment is directed by examination and symptoms rather than by the scan alone.

Pain control first, enough to allow movement. Then restoration of movement, then progressive loading and trunk control training to reduce recurrence. Manual therapy where indicated, and hydrotherapy where land-based movement is still too painful.

The recurrence rate is what makes trunk control the important part. Treating the episode and stopping there leaves the person in the same position for the next one.

Progressive weakness in both legs, numbness around the groin or inner thighs, or loss of bladder or bowel control can indicate cauda equina syndrome. This is a surgical emergency and it needs immediate hospital assessment, not physiotherapy.

We check for these at every stage of the programme, and we tell patients what to watch for at home.

Disc bulges and herniations are common findings in people with no pain at all, and they become more common with age. A scan finding on its own therefore does not explain symptoms; it has to match the examination — which nerve, which muscle, which reflex.

This matters because an alarming report read without that context produces fear, and fear produces the guarding and inactivity that make recovery slower. We go through the imaging with you and say which findings are relevant to your symptoms and which are background.

Leg pain following a nerve root — sciatica — behaves differently from back pain and is treated differently. It often improves over weeks to a few months as the inflammation around the nerve settles, and the herniation itself frequently shrinks over that period without any intervention.

Rehabilitation during that window is about keeping you moving within tolerance, protecting the nerve from positions that irritate it, and rebuilding what deconditions fast: trunk control, hip strength and walking tolerance.

Prolonged bed rest, which makes outcomes worse rather than better. Traction, which is not recommended for low back pain with or without sciatica. Passive treatment given alone with no exercise attached to it.

Manual therapy has a place, but as part of a package that includes exercise rather than as a course of treatment in its own right. If a plan consists mainly of passive sessions, it is worth asking what the exercise component is.

Returning to activity is part of the treatment rather than the reward at the end of it. Work and lifting are reintroduced progressively, with the load and the technique trained rather than avoided — because avoidance is what turns an episode into a chronic problem.

Where a job involves heavy manual handling we train that specific pattern before discharge, and the written plan says what you can lift and how the limit should progress.