Lumbar Disc Herniation (Slipped Disc)

Overview

Between each pair of vertebrae sits a disc: a tough outer ring with a soft, jelly-like centre that acts as a shock absorber. A disc herniation (often called a slipped disc, although nothing actually slips out of place) happens when the centre pushes through a weakened part of the outer ring. If the bulge presses on or inflames a nearby nerve root, you get leg symptoms — this is the most common cause of sciatica.

Disc herniations are most frequent at the two lowest levels, L4/5 and L5/S1, and typically affect people between 30 and 50, when the disc still has enough fluid to bulge but the outer ring has begun to wear. Many herniations are found on scans of people who have no pain at all, so a scan result on its own does not tell the whole story.

The natural course is encouraging. The body gradually reabsorbs much of the herniated material and the inflammation settles. Most people improve substantially over six to twelve weeks, and the large majority never need surgery.

Causes and risk factors

• Lifting something heavy with a bent, twisted spine
• Repeated bending and lifting at work or in the gym
• Prolonged sitting and driving, which load the front of the disc
• Age-related wear of the outer disc ring
• Smoking, which reduces the disc's nutrient supply
• Being overweight or having weak trunk muscles
• A family history of disc problems

How we may be able to help

Assessment comes first. We examine your lumbar movement, test the strength, reflexes and sensation in your legs, and use nerve tension tests to confirm which level is likely involved. We screen for cauda equina symptoms at every visit and will direct you to urgent care if they appear.

Our physiotherapists use manual therapy to reduce load on the affected segment and nerve-mobilising techniques to ease leg symptoms. A key part of treatment is finding your "direction of preference" — often extension-based movements — that move leg pain back towards the spine, then building this into a daily routine. As symptoms settle, we progress to trunk strengthening and lifting technique so the disc is better protected.

Our chiropractor may provide mobilisation or manipulation of stiff segments above and below the herniation where appropriate. Dry needling can relieve the muscle spasm that often locks the back in a sideways lean, and interferential therapy may be used for pain in the early stage. If leg pain is severe or there is any weakness, an online private GP consultation can be arranged to discuss medication and whether an MRI referral is warranted.

What you can do at home

• Walk little and often; avoid sitting for more than 20–30 minutes at a time
• Lie on your front propped on your elbows for a few minutes several times a day if this eases your leg pain (stop if it makes it worse)
• Use heat on the lower back to reduce muscle guarding
• Avoid heavy lifting, deep bending and sit-ups while symptoms are acute
• When you must lift, keep the load close, bend at the hips and knees, and avoid twisting
• Stay positive: the natural history of a disc herniation strongly favours recovery