Do you feel stuck with constant lower back pain? Sharp pain that makes you catch your breath, especially when you try to bend forward or sit down. Shooting pain down your leg that leaves a crawling, irritating tingling feeling in your foot. When you stand, your back looks like a question mark. You try to ‘stretch it out’, but that makes it worse. Whether you call it a disc bulge, herniation, prolapse, or slipped disc, it still hurts!

Even though an injury like this sounds scary, it doesn’t have to be. Did you know that 60-80% of lumbar disc herniation injuries can resolve within six to twelve weeks (3 months) without surgery. And within one year, 80-90% resolve completely.

Bones / Spine

Your lower back, called the lumbar spine, is made up of five large bones called vertebrae. These bones stack on top of each other to form the lower part of the spine. They have a complex shape, but they fit together perfectly. This creates a very strong foundation to carry the weight of your upper body.

Discs

Between each vertebra sits a disc, a gel-like structure that cushions a lot of the impact between the vertebrae. The discs in the lumbar spine are thick and strong to match the stability of the lumbar spine. Each disc has a tough outer layer (annulus fibrosus) that is mostly made up of collagen tissue, known for its ability to handle tensile (stretch) forces. The inside is a softer, gel-like centre (nucleus pulposus) that consists mostly of water and proteoglycans (a type of protein). The proteins bind with water, which gives the centre of the disc the ability to withstand compression. Discs have a poor blood supply, but they receive their nutrients from the bone/vertebra above and below it, through something we call the end plate. Ultimately, the bones and discs have a unique way of working together.

Ligaments

Strong bands of tissue called ligaments hold the spine together. These run along the front, back, and sides of the vertebrae, helping to stabilise the spine and limit excessive movement.

Nerves

Your spinal cord runs down the middle of the spine, and between each pair of vertebrae, spinal nerves branch out to the rest of your body. In the lower back, these nerves travel down into your hips, legs, and feet. Smaller branches of nerves innervate the outer layer (annulus fibrosus) of each disc and can register pressure and pain. Nerves give us the ability to feel different sensations (like pressure, soft touch, heat, cold, or pain) and give our muscles the ability to move. When something (like a bulging or herniated disc) puts pressure on a nerve, it causes a range of symptoms like pain, numbness, or weakness.

Muscles

The lower back is supported by several layers of muscles, including the deep core stabilisers, the larger back extensors, and muscles that connect your spine to your hips and pelvis. These muscles help with posture, movement, and spinal stability during your daily movements.

Let’s imagine what happens inside the spine when a disc starts to become injured.

It often begins quietly, with small things adding up over time. Maybe you spend a lot of time sitting, or you lift and twist regularly at work. At first, your discs cope just fine—they’re built to absorb shock and allow movement. But slowly, day after day, the load adds up.

Step 1: A little too much pressure, a little too often

Each time you bend forward, sit slouched, or lift something heavy with poor technique, pressure builds inside your spinal discs—especially in the lower back. This pressure isn’t dangerous at first, but when it happens repeatedly, it starts to take a toll.

Step 2: The outer wall starts to tire

The disc has a tough outer shell (called the annulus), but with enough repetition or strain, tiny cracks can begin to form. This part of the disc starts to fray, just like the fabric on an old seat cushion that’s been used for years.

Step 3: The inner gel starts to push outward

Inside each disc is a soft, jelly-like centre (the nucleus). When the outer layer weakens, this gel starts to move toward the damaged area. It follows the path of least resistance—slowly pressing against the thinning or torn parts of the disc wall.

Step 4: The disc begins to bulge—or break

At this point, one of two things can happen. The inner gel might start to press outward, stretching the disc wall and creating a bulge—a bit like when the side of a balloon starts to puff out.

If the outer layer gives way completely, the gel can escape through the tear. That’s called a herniation, and it’s a more serious version of the same process.

Step 5: Inflammation joins the picture

As the disc changes shape or spills some of its inner material, the body recognises this as an injury. It responds with inflammation—a natural process that sends blood flow, chemical messengers, and immune cells to the area.

While inflammation is part of healing, it also sensitises nearby nerves. Even if the disc doesn’t physically press on a nerve, the inflammatory chemicals alone can cause pain, burning, tingling, or aching. This is often why symptoms flare up, even when nothing dramatic seems to have happened.

Step 6: Nerves feel the pressure—or the irritation

If the disc bulge or herniation is large enough, it may start to compress a nerve directly. This adds mechanical pressure on top of the chemical irritation, leading to more intense symptoms. You might feel pain travelling down your leg or arm, or even experience numbness or weakness if the nerve’s ability to send signals is disrupted.

Central Disc Herniation

The disc in protruding into the centre of the spinal cord.

This type of disc herniation affects both legs equally. Symptoms include pain, numbness, weakness and pins/needles.
This could cause narrowing of the spinal column (spinal stenosis).

Posterolateral Disc Herniation

“Posterior” means backwards and “-lateral” means away from the middle (either left or right). The herniated disc protrudes backwards and to the side. This puts pressure on the nerve root (where the nerve exits the spine). These types of herniations cause pain down one of your legs, along the path of the nerve that is pinched.

• Poor posture over long periods, especially while sitting.
• Repetitive movements that strain your lower back (like bending and twisting).
• Picking up or pushing something much heavier than your body is used to.
• Weakened control of your core muscles adds strain to your spine and discs.
• Age-related changes (degeneration) lead to decreased height and flexibility of your discs.
• Exposure to vibration (like driving a car) for long or repetitive periods of time.
• Repetitive coughing or sneezing that increases abdominal pressure and pressure on discs.

Our physiotherapists are highly trained to recognize and assess disc injuries. We don’t just look at your pain, but take a comprehensive approach to get to the root of the problem. Starting with carefully listening to your history and understanding how your symptoms affect your daily life. Then, we stress and test your spinal and hip mobility, muscle strength, and nerve integrity and mobility. We understand the physiological stages of healing you’ll go through. That is why we can guide you through a structured program to recover faster and safely return to the things you love doing. Our physiotherapists are the best at diagnosing this type of problem.

Discs cannot be seen on an X-ray, but the disc spaces can be visualised between the vertebrae. Therefore, an X-ray may not be able to detect a disc bulge, but it can provide information about the bone and joint structure, as well as signs of degeneration.

It won’t be necessary to get an X-ray immediately; your physiotherapist can refer you.

Diagnostic ultrasound can be used to visualize soft tissue. That includes muscles, ligaments, nerves, tendons, and fluid. However, a sonar is not the right type of scan to image a lumbar disc as it cannot reach into the spinal joints. This is not a typical scan used to diagnose a disc bulge in your lower back.

If you need an ultrasound, your physio will refer you.

An MRI scan can image all of the structures in your lower back, including soft tissue, discs, nerves, and bones. However, it is an expensive test, and you need a specialist doctor referral. Your physiotherapist can guide you to the right specialist doctor if necessary. You do not need to get an MRI from the start.

Use of medication
Many people rely on painkillers or anti-inflammatories but don’t use them consistently or at the correct dosage. This can mean the inflammation never properly settles, and the cycle of flare-ups continues.

2. Stretching
   It’s common for patients to try and “stretch the pain away.” Unfortunately, with a disc bulge, excessive or incorrect stretching can actually irritate the disc and surrounding tissues further, while doing little to build the strength that’s truly needed for recovery.
3. Rest
   Some patients push through the pain and never give the disc a chance to calm down, while others do the opposite — too much bed rest. Neither extreme helps; the key is a balance of rest with guided movement.
4. Use of crutches
   In milder disc injuries like bulges, we sometimes see patients walking with crutches for longer than needed. This can reduce confidence in walking normally and lead to weakness in the supporting muscles.
5. Surgery mindset
   Believing that surgery is the only solution can hold back progress. Most disc bulges recover fully with structured physiotherapy, without the need for surgical intervention.
6. Walking with nerve symptoms too long
   Even if symptoms are mild, ignoring tingling, numbness, or shooting pain in the leg for too long can make recovery slower and less complete. Early intervention gives the nerve the best chance to recover fully.
7. Not finishing treatment
   A very common issue is patients who start physiotherapy or exercise programmes but stop once the pain improves. Because disc bulges can flare up and calm down, it’s easy to think the problem has “gone away.” Without completing the full programme, however, the spine is left vulnerable to repeat episodes.

Our priority is to determine the extent of disc injury and the way it affects the surrounding muscles and nerves. We test the structures surrounding your hip and lower back to clear the nerve pathway and resolve the sciatic nerve pain. Avoiding disc and nerve compression is crucial to restore normal movement of the spinal joints. We protect the surrounding muscles from overworking by strengthening the surrounding muscles, correcting compensation, and retraining the correct firing pattern. This supports your body in its ability to adapt and heal. Our practitioners bring on a change and monitor the results until it’s working, and then we magnify the effects to get even better outcomes.

The intervertebral disc has poor blood supply, compared to that af a muscle. Only the outer third has small blood vessels (capillaries). Nutrients and oxygen rich blood is limited, and will take a considerable amount of time to heal, even after the pain has subsided. Approximate time to heal is between 3 to 6 months.

With a non-surgical approach, many people start to see improvement in 6–8 weeks, but full recovery can take several months. In some cases, nerve symptoms such as tingling or mild weakness may take even longer to resolve, since nerves heal more slowly than muscles or ligaments. The important thing to remember is that steady progress is still progress. By sticking with a structured physiotherapy programme, most people can avoid surgery and return to their normal activities with confidence and stability.

A full recovery and return to sport will take longer and should not be confused with the healing period.

• General practitioner: Assists with pain management in the form of a prescription for medication or an injection for pain if needed.
• Orthotist: An orthotist can measure and provide a lumbar support brace to help with managing your pain in the early phases of your recovery.
• Biokineticist: As your pain improves, it is important to work on muscle strength and conditioning. Especially if you want to return to playing a sport or to training at the gym. This is where a biokineticist can help and often work in conjunction with physiotherapy treatment.

• Persistent, disabling pain that does not improve with non-operative treatment. This includes physiotherapy, rehabilitation, medication, and corticosteroid injections/infiltrations.
• If the pain lasts longer than 6 weeks without any change or improvement.
• Significant muscle weakness and atrophy of one or both of your legs.
• Cauda equina syndrome.

The orthopaedic surgeon or neurosurgeon will determine which type of surgery is most effective.

Take into account that surgery is only the halfway mark for a successful recovery. After surgery, you need to rest, reintegrate, strengthen, and adapt your body to the change.

• Disc herniation: A step worse than a disc bulge. Now, the disc has swelled and pushed through a tear in the annulus fibrosus into the spinal canal.
• Degenerative disc disease:  Degeneration of the lumbar vertebrae and joints leads to more disc compression, smaller joint spaces, and increased nerve compression.
•  Sciatica: Compression on the sciatic nerve that causes a combination of pins and needles, numbness, or weakness in the back of your leg and foot.
• Spondylolisthesis: One vertebra slides forward on the one beneath it. This creates extra tension and instability in that spinal joint.

• Lower back slipped disc
• Herniated disc in the lower back
• Lumbar discogenic pain
• Prolapsed disc in the lower back