Phone0790 999093 AddressBeActive Clinic, 28 Castle Street, Hertford, England

The following is an overview of a common condition that is a frequent cause of low back and leg pain, along with details of some of the current forms of treatment which may help to relieve the pain and discomfort associated with it.

It’s a normal day, you bend down to pick up that box of books you’ve been meaning to unpack for months, and as you go to stand up, you’re overcome with ‘crippling‘ back pain and a painful shooting sensation down your leg. You find yourself frozen to the spot and in need of some help! There is a good chance you have just experienced an intervertebral disc prolapse or herniation in your lower back, otherwise known as a ‘slipped disc’.

Each intervertebral disc forms the gap between each pair of vertebrae within the spine and should be both mobile and resilient. Their main functions include both allowing and restricting movement, as well as providing important shock absorption for the forces which act on and throughout the body. When we bend forward to pick up something heavy, the forces acting inside the discs increase drastically. Especially when we bend forward and lift a heavy weight without bending at the knees or keeping a straight back. Repeated episodes of this type of movement result in degeneration of the structure of the discs, which over time can lead to bulging and eventual prolapse or herniation.

Simply put, a disc prolapse or herniation is when soft part at the centre of a disc moves outside of this space. This most commonly occurs in the lumbar region of the spine (lower back), most frequently affecting the L4-5 and L5-S1 discs. Herniation of disc contents usually occurs backwards into a space which houses the spinal cord and/or nerve roots which supply the muscles, tissues and joints of the leg, hence why you will often feel leg pain, as well as back pain.

Other symptoms you may experience with a disc prolapse include weakness, pins and needles, tingling and numbness of different parts of the buttocks or legs. Symptoms are commonly felt on one side of the body, due to disc contents usually herniating towards either the left or right nerve root. On rarer occasions however, it is possible to feel symptoms down both sides. Your practitioner will note the location and nature of your symptoms, movement restrictions, and add further testing to determine which disc in the lumbar spine is affected. Symptoms in one person may vary considerably to another.

On very rare occasions, a large disc herniation at the L4-5 or L5-S1 levels could compress the nerve roots causing cauda equina syndrome. This is a medical emergency which requires immediate investigation. Tell-tale signs of cauda equina syndrome include bowel, bladder and/or sexual dysfunction, numbness in the ‘saddle’ region, as well as the more common symptoms mentioned above.

There are many ways of treating an intervertebral disc prolapse/herniation. The most commonly accepted forms of treatment include manual therapy, medication, and surgery. It is generally accepted that during the first six weeks of experiencing symptoms, a conservative approach to treatment is followed. This may include a combination of manual therapies, including spinal manipulation, and medications, such as painkillers, anti-inflammatories and muscle relaxants. Movement early on is pivotal in the recovery from a disc prolapse, so don’t spend all day sitting or laying down through fear of making things worse. Gentle movements are definitely the way forward. You may also be prescribed some spinal flexibility and strengthening exercises once initial symptoms calm down. If symptoms are severe or persist beyond six weeks, then surgery may be discussed with a specialist, such as an orthopaedic surgeon. There has been, and continues to be, much debate over which form of treatment is most beneficial for disc prolapses. Recent research suggests that both conservative and surgical approaches have similar results one year on from the initial prolapse occurring. So, a non-invasive approach should always be tried first before surgery is considered, unless a patient is exhibiting signs and symptoms of cauda equina syndrome.

It should be noted that the above description does not include all possible causes or signs and symptoms of a disc prolapse, but just the most common. Presentations may vary and it is always recommended to get a professional opinion at the earliest convenience.

Liam Storey


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