Neurorehabilitation & Pain

Patient guides › Musculoskeletal pain

Lumbar Disc Herniation: Specialist Summary

Medically reviewed by Prof. Dr. Engin Çakar, PM&R specialist · Updated

A lumbar disc herniation occurs when the inner part of an intervertebral disc protrudes and presses on nerve roots, which can cause pain, numbness or weakness in the lower back and leg. In many patients symptoms ease within weeks with non-surgical treatment. Treatment decisions depend more on the examination, the degree of nerve involvement and the course of symptoms than on the MRI image.

When to see a doctor

  • Pain lasting 2–3 weeks or getting worse
  • Promptly, if pain, numbness or tingling spreads to the leg
  • Emergency (red flags): loss of bladder or bowel control, numbness in the buttock and genital area (cauda equina syndrome), rapidly increasing leg weakness or foot drop
  • Back pain starting with fever, unexplained weight loss, a history of cancer or after significant trauma

Treatment options

  • Conservative: brief rest while staying as active as possible, patient education, appropriate pain medication
  • Physical medicine and rehabilitation: an individual exercise programme, manual therapy and physical modalities when needed
  • Interventional pain treatment: procedures such as image-guided epidural injections in selected patients
  • Surgery: for progressive weakness, cauda equina syndrome, or pain that seriously limits daily life despite adequate conservative treatment

Surgery or not? When the decision is unclear, a neurological examination, the match between MRI findings and symptoms and, when needed, EMG (electromyography) to objectively assess nerve root involvement all help. The aim is to distinguish patients who may benefit from surgery from those who can be managed conservatively; the decision is made with the patient, in collaboration with neurosurgery.

Frequently asked questions

Does every disc herniation need surgery? No. Surgery is considered in specific situations; many patients are treated without it.

Does a herniation on MRI mean it is the cause of the pain? Not always; disc changes are also seen in people without pain. Findings are interpreted together with the examination.

Can I exercise with a disc herniation? Appropriate exercise is recommended for most patients; the programme should be set by a doctor and physiotherapist.

What does EMG show? Whether a nerve root is affected, and to what degree.

Sources

Turkish version: doktorfizik.com/rehber/bel-fitigi/