What a disc problem is and how it differs from ordinary lower back pain
An intervertebral disc is made up of a tough fibrous ring and a gel-like nucleus. The term “disc disease” covers a wide range of changes: from loss of hydration and disc height, through a bulge, to a herniation, in which part of the nucleus moves beyond the outline of the ring. It most often affects the two lowest levels – L4-L5 and L5-S1 – which carry heavy loads while also moving a lot.
The MRI report on its own does not tell us what is causing the pain. Disc changes are very common in people with no symptoms, which is why we manage most episodes of lower back pain in a similar way, whatever the scan shows. It is different when a herniation irritates a nerve root – then leg pain comes to the fore, often with tingling. We describe that picture in more detail on the page about sciatica.
How we check whether the symptoms come from the disc
We start with the history: when the pain began, what makes it worse, whether it travels below the knee, and how it responds to sitting, walking and lying down. Then we examine sensation, strength and reflexes – difficulty standing on your toes or on your heels hints at which nerve root is irritated. Nerve tension tests and repeated movements in different directions show whether the symptoms retreat towards the spine or travel further down the leg.
If you have an MRI result, we compare it with the examination. If you do not – you do not need one to start. We refer you to a doctor when neurological symptoms are getting worse, when the pain is very severe and does not respond to treatment, or when any of the warning signs described on this page appear.
Conservative treatment – what actually works
In most people the symptoms ease clearly within a few weeks, and a full return takes anywhere from a few weeks to a few months. The role of physiotherapy is to take you through that period with as little pain as possible and without losing function, and then to rebuild in a way that reduces the risk of recurrence.
The foundation is movement matched to your current state: positions that ease the pain, walking as far as you can tolerate, then exercises for trunk control and strengthening of the glutes and legs. Manual therapy and soft tissue work help reduce pain and tension, but they are an add-on – they will not replace exercise. Nor do we promise to “put the disc back in place”, because that cannot be done by hand.
Numbness in the saddle area or problems passing urine or controlling your bowels mean you need to go to A&E (SOR) immediately. A doctor considers surgery mainly with increasing weakness or severe leg pain that does not settle despite consistent treatment. Physiotherapy is needed after surgery too – we carry it out in line with the surgeon’s recommendations.
Getting back to sitting, work and training
Most people with a disc problem do not have to give up either office work or the gym. What changes is the route back to full loads: shorter spells of sitting broken up by movement, gradually longer walks, and a return to lifting that starts with light weights and well-practised technique. We are guided by how the symptoms in the leg respond – if they stay stable, we move on; if they travel further down, we slow down for a while.
If this is not your first episode, or the word “herniation” has made you afraid to get moving again, start with a thorough assessment. You can arrange an appointment via the Contact page.