Typical symptoms of a herniated disc
- Deep low back pain, sometimes more on one side
- Pain running from the buttock down the leg, often below the knee
- Numbness, tingling or burning in the leg or foot
- Pain that gets worse with bending forward, sitting for long periods, coughing or sneezing
- Marked stiffness in the morning or after staying still for a while
- In some people, weakness in the ankle or big toe
Causes and risk factors
Discs gradually lose water over the years and small tears can form in their outer ring. A herniation usually isn't caused by a single movement; it tends to appear when a load comes on top of this slow process. The size of the herniation on an MRI doesn't always match how much it hurts — plenty of people with no pain at all have disc changes on their scans.
- Long hours of sitting and little movement during the day
- Jobs that involve frequent, repeated bending and lifting
- Smoking and low general fitness
- Excess weight and weak trunk muscles
- A family history of disc herniation
How I work with a herniated disc
My aim isn't just to dampen the pain. It's to find out which movements make it better or worse and to get your back used to the demands of your daily life again.
Assessment
In the first session we talk about how the pain started, how it changes through the day and what you find hardest. I use movement tests, nerve tension tests and checks of your reflexes, sensation and muscle strength to see how much the nerve root is affected. If you have an MRI or doctor's reports, we go through them together.
Manual therapy
During the painful phase, joint mobilisation and soft tissue techniques around the spine and hips can make movement easier and help you get started with exercise. When pain spreads into the leg, neural mobilisation may also be part of the plan.
Exercise therapy
We start with movements in the direction that eases your pain, then build a gradually progressing programme that strengthens your trunk and hip muscles. The exercises you do regularly at home are the most important part of treatment.
Education
We talk about what a herniated disc actually means, why pain and tissue damage aren't the same thing, your sitting and lifting habits, and what to do if the pain flares. Fear of movement can slow recovery down.
How many sessions will I need?
I can only give you an exact number after the first assessment. We usually start with 2–3 sessions a week and space them out as you improve; for many people a total of 6–12 sessions is a realistic range. How long you've had the problem, any nerve signs, and how consistently you do your exercises all affect this.
What you can do at home
- Don't stay in bed for long; keep moving with short walks as far as the pain allows.
- Break up long periods of sitting by getting up and walking for a few minutes every 30–45 minutes.
- When picking something up from the floor, bend your knees and keep the load close to your body.
- Until you've been assessed, avoid movements that clearly increase the pain or send it down your leg.
When to see a doctor first
If you have any of the following, see a doctor without delay — or go to the emergency department — before starting physiotherapy:
- Loss of bladder or bowel control, or being unable to pass urine
- Numbness around the groin, buttocks or inner thighs (saddle numbness)
- Rapidly increasing weakness in the leg, or foot drop
- Back pain that started after a fall or accident
- Pain together with fever, unexplained weight loss or a past history of cancer
- Pain that doesn't ease at all with rest or changing position and gets worse at night
Frequently asked questions
Can a herniated disc heal without surgery?
Do I need an MRI before starting physiotherapy?
Is walking bad for a herniated disc?
Can I have physiotherapy if I've already had surgery?
This page is for general information only and does not replace a medical diagnosis or examination. If your symptoms are severe or getting worse quickly, see a doctor first.