Living with a herniated disc
A herniated disc can feel very scary. You might wake up with sudden, sharp leg pain after lifting, or develop deep arm pain that shoots down past your elbow when you turn your head. Sitting, coughing, or sneezing can make the pain surge. Sleep can be broken, getting dressed is awkward, and work or childcare can feel overwhelming.
Most herniated discs happen in the lower back and cause sciatica, which is leg-dominant pain that follows a nerve pattern. In the neck, a herniated disc can cause arm pain and tingling called cervical radiculopathy.¹ ³ ⁴ The reassuring part is that, for most people, symptoms improve over weeks to a few months with time, activity, and guided rehabilitation. Only a minority need injections or surgery, and true emergencies like Cauda Equina Syndrome are rare (serious compression of the nerve roots at the bottom of your spinal cord).¹ ² ⁵
Did you know?
Many herniated discs shrink on their own. Imaging studies show that a high proportion of herniated discs, especially those where material has broken through (extrusions or sequestrations), partially or fully resorb over time. This helps explain why so many people with sciatica improve without surgery.¹² ¹⁷
What are the symptoms of a herniated disc?
Lumbar herniated disc (sciatica)
- Sharp, burning, or electric pain down one leg, often going below the knee
- Leg pain is usually worse than back pain
- Pain follows a strip of skin (dermatome), for example down the back or side of the leg
- Numbness, tingling, or “pins and needles” in the foot or leg
- Weakness when lifting the foot, standing on tiptoes, or straightening the knee
- Pain increased by coughing, sneezing, or straining, and reproduced by straight leg raise tests¹ ⁵
Cervical herniated disc (cervical radiculopathy)
- Neck pain plus arm pain that travels below the elbow
- Numbness or tingling in a specific part of the arm or hand
- Weakness in shoulder, elbow, wrist, or hand movements
- Symptoms may worsen with neck extension, rotation, or loading, and can ease when resting the arm on top of the head³ ⁴
Most people with a herniated disc also have some spine pain, but the limb symptoms are usually the most intense and bothersome. Red flag symptoms that need urgent help are listed below.
Clinical insight
What causes herniated disc pain?
Discs are tough, fibrous rings with a gel-like center that act as shock absorbers between your vertebrae. Over time, or after a sudden strain, small tears can form in the outer ring and the inner material can bulge or leak out, irritating or compressing nearby nerves. Factors that can contribute include:
Age-related disc changes
- Discs naturally lose water and height as we age, which can make them more vulnerable to tears and bulging.¹ ³
Repetitive load and posture
- Repeated bending, twisting, heavy lifting, or vibration exposure at work can stress the discs.
- Sudden flexion or rotation under load can trigger an acute herniation.³
Lifestyle and health factors
- Smoking, higher body weight, and low physical activity are linked with higher disc degeneration and herniation risk.¹ ³ ⁵
Genetic and structural factors
- Some people inherit disc traits that make herniation more likely.
- In the neck, disc herniation often occurs together with bony overgrowth that narrows the nerve exit hole.³ ⁴
It is important to know that disc bulges and even herniations show up on imaging in many people without pain, so scan findings always need to be matched with your symptoms and examination.²
When should I see a doctor for a herniated disc?
Most new episodes of sciatica or arm radicular pain from a herniated disc improve over several weeks with self management and physical rehabilitation. But some symptoms mean you need urgent or emergency care.
Call emergency services or go to the emergency department right away if you notice:
- New difficulty starting to pee, being unable to pee, or leaking urine you cannot control
- Loss of bowel control or new severe constipation with back and leg symptoms
- Numbness around your anus, genitals, or inner thighs (saddle area)
- Severe pain down both legs, or rapidly worsening weakness in one or both legs
- A history of serious trauma (for example a fall from height or car crash) with severe back pain
These can be signs of cauda equina syndrome or serious spinal injury, which need urgent MRI and often emergency surgery.¹ ¹² ¹⁵
You should arrange a prompt medical review (for example with your primary care clinician or a spine specialist) if:
- You have leg or arm-dominant pain that has not improved over 4 to 6 weeks
- Pain is so intense that you cannot sleep, work, or manage basic daily tasks despite simple medicines and activity changes
- You notice new or progressing weakness, such as foot drop, trouble gripping, or difficulty standing on your toes
- You have a history of cancer, unexplained weight loss, fever, night sweats, or feel systemically unwell along with your spine symptoms
If you’re unsure, a clinician can help rule out serious causes and guide treatment.
How is a herniated disc treated?
Treatment focuses on helping your symptoms settle while your body gradually calms the nerve irritation and, in many cases, reabsorbs some of the disc material. Most people start with non surgical care and only a subset go on to injections or surgery.
Education and staying active
- You are usually encouraged to keep moving within your limits, rather than staying in bed. Short walks, gentle position changes, and simple activities are better than long periods of lying still.¹ ⁵
- A pain-monitoring approach (where pain can increase slightly during activity but settles again within a reasonable time) helps you stay as active as possible without overdoing it.
- Reassurance that most radicular pain improves over weeks to a few months is important for reducing fear and guarding.¹ ⁵
Exercise based rehabilitation and physical therapy
Early on, comfortable positions and gentle movements that reduce leg or arm symptoms are used, sometimes called directional preference or McKenzie-type exercises.
- As pain allows, rehabilitation usually includes:
- Research for sciatica specific exercise is mixed, but overall supports supervised, impairment-based programs that are integrated with education and self management.⁶ ⁷
Medications
- Short courses of non steroidal anti inflammatory drugs and simple pain relief can help manage pain, as long as they are safe for you.
- National Institute for Health and Care Excellence (NICE) guidance advises against routine use of gabapentinoids, other antiepileptic medicines, benzodiazepines, and oral steroids for sciatica, and recommends avoiding opioids for chronic sciatica due to limited benefit and important risks.¹ ⁸
Epidural steroid injections (ESIs)
- For lumbar disc related sciatica, epidural steroid injections can give short to medium term pain relief for some people, reduce early opioid use, and sometimes delay or avoid surgery.⁸
- They do not appear to change the underlying disc problem or provide reliable long term benefit.⁸
- There are rare but serious risks such as stroke, and image guidance and careful choice of steroid are widely recommended to help reduce them.⁸ ⁹ ¹⁰
Surgery
Lumbar microdiscectomy
- When imaging matches your symptoms and you have leg-dominant pain from a herniated disc, microdiscectomy (removing the part of the disc that is pressing on the nerve) can provide faster relief of leg pain and disability compared with continuing conservative care.⁵ ¹¹
- Large trials and long term studies show that surgery offers clear early advantages, but by 1 to 2 years many people who chose nonoperative care have also improved and average outcomes between groups are often similar. Some people maintain longer term benefits from surgery, but this varies.⁵ ¹¹ ¹⁷
These decisions are usually made together with a spine surgeon after weighing your symptoms, function, values, and risks.¹ ³ ¹¹ ¹⁷
Cervical radiculopathy
- Most people with cervical radiculopathy improve within 6 to 12 weeks with nonoperative care.³ ¹⁴
- Selective cervical nerve root injections may be considered for short term relief in persistent cases, after a careful discussion of risks.
- Anterior surgery (like a cervical discectomy and fusion or a foraminotomy) is generally reserved for ongoing radicular pain with matching imaging or for progressive nerve-related symptoms, and is a separate pathway from cervical myelopathy (spinal cord compression).³ ⁴ ¹⁴
Common reasons to consider surgery
- Severe, persistent leg or arm pain that has not improved enough after an adequate trial of non surgical care (often 6 to 12 weeks)
- Progressive or severe weakness in a specific muscle group related to the compressed nerve
- Cauda equina syndrome, which requires emergency decompression
Sword's approach
Sword Health helps people manage pain and movement issues with expert-guided AI care you can use from home. Our model combines clinical support with modern technology, designed to work around your life.
