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EPISODE 46: Disc Herniations - Anatomy, Symptoms, and Treatment


One of the most common low back injuries is the disc herniation. Most people know at least one person who was told by their physician that they herniated a disc in their back or that they have "bulging discs." At Physical Therapy San Pedro we see a ton of patients on a daily basis in our center with this injury. For this reason, we have become experts in treating herniated discs! If you are struggling with Low Back Pain, numbness, tingling, or weakness in your legs, or you were told that you have a disc bulge, then this blog is for you. We will be discussing how a person herniates a disc in their back, common symptoms, treatment options and giving you a full anatomy lesson.


Let's dive in!


A herniated disc, also known as a slipped or ruptured disc, occurs when the inner gel-like core of an intervertebral disc (nucleus pulposus) protrudes through a tear or rupture in the outer fibrous ring (annulus fibrosus). This condition can cause pain, numbness, tingling or weakness in the legs due to the pressure exerted on nearby nerves or the spinal cord. A disc herniation can occur anywhere in your spine, but around 90% of disc herniations occur in the lumbar region, with the L4-L5 and L5-S1 levels being the most frequently affected. The anatomy of the lumbar spine plays a crucial role in understanding why it is particularly susceptible to disc herniations.


Here’s an overview of the Lumbar Spine:


lumbar disc herniation

  1. Structure:

    The lumbar spine consists of five vertebrae, labeled L1 to L5 and 5 intervertebral discs.

    1. Vertebrae are the largest and strongest in the spine, designed to bear much of the body’s weight and stress. The vertebrae are made up of 3 parts:

      1. Body - The anterior portion that supports the weight.

      2. Pedicles and Laminae- Form the vertebral arch that protects the spinal cord.

      3. Processes- Projections for muscle and ligament attachment, including the spinous and transverse processes.

    2. Intervertebral Discs are made up 2 parts:

      1. Annulus Fibrosus: The tough, outer fibrous ring of the disc.

      2. Nucleus Pulposus: The soft, gel-like center that provides cushioning and flexibility.

  2. Nerve Roots and Spinal Cord

    1. Spinal cord ends around L1-L2, but the nerve roots continue downward in a bundle called the cauda equina.

    2. Nerve Roots exit through the intervertebral foramina.Each lumbar vertebra has a pair of nerve roots (one on each side).

  3. Function and Movement : The lumbar spine allows for flexibility and movement, including flexion, extension, lateral flexion, and rotation. It also provides stability and supports the upper body’s weight.


Now that you understand the complicated lumbar spine and the structures involved, let's break down how a disc herniation occurs.


Disc herniations can be caused by several different factors but often people are unsure of how or when it occurred because a disc herniation often occurs over time with poor posturing or repeated movements that put stress on the discs. Another common report from clients is "I went down to pick something up from the ground and I felt a sharp pain in my back or a pop and tingling down my leg."


Some common specific causes of a herniated disc include:

  • Mechanical Stress: from activities such as lifting, twisting, and bending, making the intervertebral discs prone to injury.

  • Degeneration: age-related wear and tear can weaken the annulus fibrosus, allowing the nucleus pulposus to protrude or herniate.

  • Trauma: sudden forces from accidents or falls can cause the disc to herniate.


If you are thinking to yourself that you might have bent or twisted the wrong way or you feel and you can relate to a cause above and you are wondering what symptoms that you may be experiencing if you have a disc herniation we are heading there next!


Some common Symptoms we see in clinic from Lumbar Disc Herniation include:

- Pain: lower back pain that can radiate to the buttocks, legs, and feet (sciatica).

- Numbness and Tingling: sensation changes in the leg and foot.

- Weakness: muscle weakness in the lower extremities, affecting mobility.

- Reflex Changes: diminished reflexes in the knee or ankle if the herniation is severe


So now that you are aware of common causes and symptoms, let's discuss how we diagnose and treat a herniated disc. I mean ultimately, you want to know how to get help. Below we are going to cover options for treatment.


There are a couple of ways we can figure out if this is the problem you have. You might find yourself in a Physical Therapists' or Chiropractor's office first with Low Back Pain and if so, you will be taken through a series of clinical testing in order to confirm that this is the problem. If you go to see your physician first,

they will likely do some imaging and order an MRI and CT scan to confirm the diagnosis and assess the extent of the herniation. Your physician will likely begin with conservative treatment which may include: physical therapy, pain medication, and epidural steroid injections. If your disc herniation is severe, they may elect in surgical treatment and recommend a Microdiscectomy, laminectomy or disc replacement in severe cases.


Physical therapy is a common and effective treatment for disc herniations and we know a lot about this type of treatment because this is what we do everyday. The goal with physical therapy is to reduce pain, improve function, and prevent future injuries.


Here are some common physical therapy treatment options for a disc herniation:

  1. Education and Activity Modification

  • Education is the most important part of treatment and includes teaching proper body mechanics, functional transitions and ways to avoid activities that exacerbate your symptoms. What you do outside of the clinic is so much more important than what we do in it. If you keep doing things that irritate your injury it will not heal.

2. Pain Relief Techniques

  • Physical Therapists will utilize a variety of methods to reduce pain, some of which include heat and cold therapy, cupping, taping, electrical stimulation, traction and manual therapy to manage pain.

3. Manual Therapy Techniques

  • Mobilization and Manipulation are great to get the bones and joints moving a little better.

  • Soft Tissue Mobilization is a great technique to reduce muscle tightness and improve circulation around the affected area.

4. Therapeutic Exercise

  • This is our bread and butter at PTSP! The goal is to get moving and strong. The pathway to recovery utilizing exercise as a tool starts with stabilization and centralization of the disc herniation.

    • Stabilization Exercises include exercises to improve the stability and coordination of the spine, such as balance training and proprioception exercises.

    • Core Strengthening Exercises strengthening the abdominal and back muscles provides better support for the spine.

    • McKenzie Method for centralization is a set of specific exercises designed to centralize the pain (bring it from the legs to the spine) from a disc herniation

      • Direction preference exercises: based on the person's directional preference (movements that reduce or centralize their pain), ie Flexion, extension, side-flexion

      • To increase extension the progression is prone lying>prone prop>prone press up>standing extension

  • While focusing on centralization and stabilization we will add in flexibility, mobility and progress trunk and lower body strength. The goal is getting you stronger than you were before you got injured.

5. Guided plan to Return to Recreational and Sports

  • Another Key to a successful rehab process is a structured plan to gradually return you back to all of your activities, workouts, hobbies and sports while minimizing the risk of re-injury. A good physical therapist will make sure everything you need to do in your life is performed in the clinic and tested prior to releasing you back to that activity.


Each treatment plan is tailored to the individual based on the severity of the herniation, the patient’s symptoms, and their overall health and fitness level. Physical therapists work closely with patients to monitor their progress and adjust the treatment plan as needed. This process could take anywhere from 4 weeks to 3-4 months depending on the severity of the condition. It takes consistency and participation on the part of the patient to see the end results. If you show up and do the work you can heal through this injury with flying colors!


We hope this information helped you gain a better understanding of Disc Herniations. To learn more about the other types/causes of low back pain, Follow and LIKE our Blog and subscribe to our email list.


Click here if you are interested in booking a session or getting more information! https://www.physicaltherapysanpedro.com/sports 


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The PTSP Docs

Dr. Brown, Dr. Bay, Dr. Silverton, Dr. Yana

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