Disc Herniation

Did you know that 50 to 80% of the adult population will experience lower back pain at some point in their lives? A simple wrong movement can quickly cause back pain. Sometimes, you may feel a locking sensation, making it difficult to perform tasks that require bending forward. If you struggle to put on your socks and even a simple sneeze worsens your pain, you might be dealing with a herniated disc. How can you be sure it’s really a herniated disc? Is your vertebra out of place?

In this article, you will learn more about lumbar disc herniation, its causes, and the available treatment options.

 

What is a Herniated Disc?

A herniated disc refers to a problem with the intervertebral disc, a small cushion located between each of your lumbar vertebrae. A common myth is that a herniated disc occurs when the disc moves out of its usual space. Another misconception is that your vertebra is displaced. This is false. The disc is surrounded by a fibrous ring that holds a gel-like core in place. This core helps absorb shock in your spine. The term “hernia” is non-specific and refers to a range of conditions where the core material moves outward from the disc.

“A herniated disc is a localized displacement of disc material beyond the limits of the intervertebral disc space.” (Jordan, 2011)

For example, during a forward bending combined with rotation, the nucleus may be pushed backward against the ring, creating a bulge. This bulge is called a protrusion (1), the first of four herniation types. With age or greater force, the ring may partially tear, pushing the nucleus further outward and increasing pressure on the annulus — this is called a prolapse (2). In rare cases, the nucleus may partially escape the ring, known as an extrusion (3). The most advanced form is a sequestered herniation (4), where a piece of the nucleus detaches and lodges in the spinal canal.

 

Should You See a Doctor?

Yes and no. Your physiotherapist can identify the signs and symptoms that require medical attention and can reassure you about the nature of the problem. A herniated disc is confirmed through imaging such as an MRI. However, this exam is not always necessary, as a herniation can exist anatomically but be asymptomatic. Every lower back problem is unique, and your healthcare professional will guide you through treatment and necessary tests. Certain signs or your injury history may require medical attention:

• Loss of sensation in the genital or anal area
• Motor deficits
• Significant neurological signs
• History of cancer
• Major trauma

Your physiotherapist is trained to recognize these issues and will refer you to a physician if needed.

 

Where Does the Pain Come From?

Pain in the body travels like an electrical current along nerves. The gel-like nucleus itself is not innervated and cannot generate pain. Only the outer edge (annulus) of the disc is innervated and is often the source of pain in a herniation. Pain can also result from compression or local inflammation of this structure. Nearby structures, such as ligaments, are innervated by the same nerves and may contribute to the pain.

The herniation may compress a nerve root. These roots emerge between each spinal joint and innervate the legs. Compression can trigger pain along the nerve path, most commonly the sciatic nerve.

Other adjacent structures can also cause similar pain:

• Lumbar facet joints
• Ligaments
• Muscles
• Vertebral body

 

Why Leg Pain?

A herniated disc can cause leg pain. Nerves originating from the spine can be irritated by inflammation from the herniation or adjacent structures. Nerve compression triggers pain along the nerve’s path, often the sciatic nerve. Pain can extend from the lateral thigh to the buttocks, down to the ankle and toes. Numbness and tingling are common.

 

How Does a Herniated Disc Develop?

A herniation can result from changes in disc pressure. Causes range from a simple movement, like picking up an object, to a fall during snowboarding. The most common cause is age-related disc degeneration. Any movement that affects disc pressure can increase pain. Poor sitting posture on a sofa or at work can increase disc pressure and prolong symptoms. Repeated movements with even mild effort can trigger pain from a pre-existing herniation — this is the most frequently observed clinical scenario.

 

What to Do if You Have This Condition

Treatment depends on the severity and duration of your symptoms. Did you know a herniated disc can sometimes resolve on its own? In practice, treatment focuses on pain management and restoring mobility rather than “fixing” the disc itself.

Physiotherapy approaches include:

• Manual Therapy: Hands-on treatment of musculoskeletal problems through joint and soft tissue mobilization. Prescribed therapeutic exercises are part of this approach.
• McKenzie Method: Developed in the 1950s in New Zealand by Robin McKenzie, this method is based on movement and changing pain location. It encourages active patient involvement in recovery through repeated lumbar extension or flexion exercises that progress according to symptoms. More info
• Motor Control Training: Often used in less acute phases, this approach retrains stabilizing muscles and teaches safe movement patterns, such as proper lifting, bending, or shoveling. Exercises may resemble Pilates or yoga and are adapted from traditional strength training movements.

Your physiotherapist will guide you to prevent re-injury, improve function, and safely return to daily activities or sports.

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