Complete Guide to Herniated Disc Treatment

A herniated disc is one of the most common causes of back pain and sciatica, affecting millions of people each year. Understanding your treatment options and the natural history of disc injuries can help you make informed decisions about your care. At M.O. Therapy in Markham, we help patients with herniated discs recover through evidence-based conservative treatment.

Understanding Disc Herniation

Spinal Disc Anatomy

Intervertebral discs sit between each vertebra in your spine, providing cushioning and allowing movement. Each disc consists of:

Nucleus Pulposus:

• Gel-like center of the disc
• Contains water and proteoglycans
• Provides shock absorption
• Distributes forces evenly

Annulus Fibrosus:

• Tough outer ring of fibrous tissue
• Multiple layers of collagen fibers
• Contains the nucleus
• Resists rotational and bending forces

What Is a Herniated Disc?

A herniated disc occurs when the inner nucleus pushes through a tear in the outer annulus. This can:

• Compress nearby nerve roots
• Cause chemical irritation of nerves
• Create inflammation in the area
• Result in pain, numbness, and weakness

Types of Disc Problems

Disc Bulge:

• Disc extends beyond normal boundaries
• Nucleus remains contained
• May not cause symptoms
• Very common with age

Disc Protrusion:

• Focal extension of disc material
• Annulus still intact
• May contact nerve roots
• Often symptomatic

Disc Extrusion:

• Nucleus breaks through annulus
• Still connected to disc
• Often compresses nerves
• Usually causes significant symptoms

Sequestration:

• Fragment separates from disc
• Free fragment in spinal canal
• May migrate
• Often requires medical attention

Symptoms of Herniated Disc

Lumbar (Lower Back) Herniation

The most common location for disc herniation.

Common Symptoms:

• Low back pain (may be severe initially)
• Leg pain (sciatica) following nerve distribution
• Numbness or tingling in leg or foot
• Weakness in specific muscle groups
• Pain worse with sitting, bending, or coughing
• Relief with lying down or walking

Distribution by Level:

• L4-L5: Pain/numbness in outer leg and top of foot, weakness with ankle/toe extension
• L5-S1: Pain/numbness in back of leg and outer foot, weakness with toe flexion and heel raise

Cervical (Neck) Herniation

Less common but can cause significant problems.

Common Symptoms:

• Neck pain and stiffness
• Arm pain radiating from shoulder to hand
• Numbness or tingling in arm or hand
• Weakness in arm or hand muscles
• Pain worse with neck extension or rotation
• Headaches (sometimes)

Red Flags Requiring Immediate Attention

Seek immediate medical care for:

• Cauda equina syndrome symptoms:
  • Bowel or bladder dysfunction
  • Saddle area numbness
  • Progressive weakness in both legs
• Severe progressive weakness
• Significant trauma preceding symptoms
• Fever with back pain
• Unexplained weight loss

Diagnosis

Clinical Examination

Your healthcare provider will assess:

• Pain location and distribution
• Neurological function (strength, sensation, reflexes)
• Range of motion
• Provocative tests (straight leg raise, etc.)
• Functional limitations

Imaging Studies

MRI (Magnetic Resonance Imaging):

• Gold standard for disc visualization
• Shows disc, nerves, and soft tissues
• Can identify herniation location and size
• May show incidental findings

Important Note on Imaging: Many people have disc abnormalities on MRI without symptoms. Imaging findings must correlate with clinical presentation.

CT Scan:

• Better for bone detail
• May show disc herniation
• Used when MRI contraindicated

X-Ray:

• Cannot show disc herniation directly
• Shows bone alignment
• Rules out other conditions
• Often first imaging study

Natural History of Disc Herniation

Understanding the natural course of disc herniation is important for treatment decisions:

• Most herniated discs improve significantly within 6-12 weeks
• The body naturally absorbs herniated disc material over time
• Larger herniations often improve more than smaller ones
• 90% of patients improve with conservative treatment
• Surgery is rarely needed when symptoms are improving

Conservative Treatment Options

Physiotherapy

Physiotherapy is a cornerstone of herniated disc treatment at M.O. Therapy.

Goals:

• Reduce pain and inflammation
• Restore function and mobility
• Prevent recurrence
• Avoid surgery when possible

Treatment Components:

Manual Therapy:

• Soft tissue mobilization
• Joint mobilization
• Neural mobilization techniques
• Muscle energy techniques

Exercise Therapy:

• Core stabilization exercises
• McKenzie-based directional preference exercises
• Progressive strengthening
• Flexibility work as appropriate

Education:

• Understanding the condition
• Activity modification guidance
• Ergonomic recommendations
• Self-management strategies

Modalities:

• May include heat/ice
• Electrical stimulation
• Traction (in selected cases)
• Dry needling

Activity Modification

Acute Phase:

• Avoid prolonged sitting
• Limit bending and lifting
• Stay as active as tolerated
• Avoid bed rest (counterproductive)

Recovery Phase:

• Gradual return to activities
• Avoid heavy lifting until improved
• Continue exercise program
• Listen to body signals

Medication Options

Your physician may recommend:

Over-the-Counter:

• NSAIDs (ibuprofen, naproxen)
• Acetaminophen for pain
• Topical medications

Prescription:

• Muscle relaxants
• Oral steroids (short courses)
• Nerve pain medications
• Opioids (short-term, acute cases only)

Injection Procedures

Epidural Steroid Injections:

• Deliver anti-inflammatory medication to the affected area
• May provide temporary relief
• Allow participation in physiotherapy
• Not a cure, but can help manage symptoms

When Is Surgery Needed?

Surgery is considered when:

• Significant weakness that isn't improving
• Cauda equina syndrome (emergency)
• Failure to improve after 6-12 weeks of conservative care
• Intolerable symptoms despite treatment
• Progressive neurological deficits

Common Surgical Procedures:

Microdiscectomy:

• Most common surgery for herniated disc
• Minimally invasive removal of disc fragment
• High success rates for leg pain relief
• Usually outpatient procedure

Laminectomy:

• Removes bone to create more space
• Often combined with discectomy
• For stenosis associated with herniation

Disc Replacement:

• Artificial disc placed after disc removal
• Maintains motion at the level
• Selected cases only

Recovery Timeline

Conservative Treatment

Weeks 1-2:

• Focus on pain management
• Gentle movement and walking
• Avoid aggravating activities
• May see gradual improvement

Weeks 2-6:

• Progressive exercise program
• Gradual increase in activities
• Many patients significantly improved
• Continue physiotherapy

Weeks 6-12:

• Return to most normal activities
• Strengthen and stabilize
• Address any residual symptoms
• Develop long-term prevention plan

Beyond 12 Weeks:

• Full recovery expected for most
• Continued maintenance exercises
• Lifestyle modifications as needed
• Re-evaluation if symptoms persist

Post-Surgery Recovery

Weeks 1-2:

• Walking and light activities
• Avoid bending, lifting, twisting
• Wound healing

Weeks 2-6:

• Gradual increase in activities
• Begin physical therapy
• Progressive walking program

Weeks 6-12:

• Return to most activities
• Continued strengthening
• Avoid heavy lifting

Months 3-6:

• Full activity including sports
• Ongoing core strengthening
• Prevention strategies

Prevention of Recurrence

Core Strengthening

A strong core protects the spine:

Essential Exercises:

• Dead bugs
• Bird dogs
• Side planks
• Modified planks
• Bridges

Proper Body Mechanics

Lifting Techniques:

• Bend at hips and knees, not back
• Keep load close to body
• Avoid twisting while lifting
• Ask for help with heavy items

Sitting Posture:

• Lumbar support
• Regular position changes
• Stand and move frequently
• Ergonomic workspace setup

Lifestyle Factors

• Maintain healthy weight
• Don't smoke (impairs disc nutrition)
• Regular exercise
• Stay hydrated
• Address stress and sleep

Treatment at M.O. Therapy

Physiotherapy

Our physiotherapists specialize in spine conditions:

Assessment:

• Thorough examination
• Movement analysis
• Functional testing
• Treatment planning

Treatment:

• Manual therapy
• Exercise prescription
• Education and self-management
• Return-to-activity guidance

Massage Therapy

Our RMTs help with:

• Muscle tension and spasm
• Pain management
• Mobility improvement
• Recovery support

Chiropractic Care

Chiropractic treatment may include:

• Spinal assessment
• Appropriate manual techniques
• Exercise recommendations
• Lifestyle modifications

Frequently Asked Questions

Will my herniated disc heal on its own? Many herniated discs improve significantly with time and conservative treatment. The body naturally absorbs herniated disc material, and most patients recover without surgery.

How long does it take to recover from a herniated disc? Most patients see significant improvement within 6-12 weeks with conservative treatment. Full recovery may take 3-6 months. Some patients improve faster, while others take longer.

Can I exercise with a herniated disc? Yes, appropriate exercise is actually important for recovery. Walking, swimming, and specific therapeutic exercises can help. Avoid activities that increase symptoms, and follow guidance from your physiotherapist.

When should I consider surgery? Surgery is typically considered if symptoms aren't improving after 6-12 weeks of conservative care, if there's significant or progressive weakness, or if symptoms are intolerable despite treatment.

Book Your Assessment

If you're dealing with back pain or suspected disc herniation, M.O. Therapy in Markham can help. Our team provides comprehensive conservative care to help you recover.

Call (905) 201-5827 or book online for your assessment. We offer direct billing and same-day appointments for acute conditions.