Diagnosis & treatment
of a herniated disc

How is a herniated disc diagnosed?

Your clinician will usually start with your story and a physical exam. Imaging is often not needed at first, unless there are warning signs or you are planning a procedure.¹ ² ³ ¹³

1. History: your story

Your clinician will ask about:

• Where your pain is and where it travels
• Whether leg or arm pain is worse than back or neck pain
• When symptoms started and what triggered them
• What makes pain worse, such as sitting, coughing, or turning your head
• Any numbness, tingling, or weakness
• Work and daily activities, such as lifting or long sitting
• Any history of cancer, infection, major trauma, or recent weight loss¹ ⁵ ¹³

These details help them decide if your pattern fits a lumbar herniated disc (sciatica) or cervical herniated disc (cervical radiculopathy), and whether serious causes are likely.¹ ³ ⁵

2. Physical examination

A focused exam usually includes:

• Checking leg or arm strength (myotomes)
• Testing touch and pin sensation in the limbs (dermatomes)
• Reflexes at the knee, ankle, biceps, and triceps
• Straight leg raise or slump tests for sciatica
• Spurling’s test (mild head compression with neck bending backwards) and arm abduction relief for cervical radiculopathy
• Simple walking and balance checks¹ ³ ⁴ ⁵

The goal is to see whether one specific nerve root looks irritated, and to check how much this affects your function.

3. Red flag screening

Your clinician will ask about and check for red flags that need urgent attention, such as:¹ ¹² ¹⁵

• New trouble peeing, being unable to pee, or leaking urine
• Loss of bowel control or new severe constipation
• Numbness in the saddle area (around genitals and anus)
• Severe pain down both legs or quickly worsening leg weakness
• Fever, feeling very unwell, or a history of cancer
• Major trauma, such as a fall from height or car crash

These can be signs of cauda equina syndrome (serious nerve compression that needs urgent surgery), fracture, infection, or cancer and need urgent MRI and specialist review.¹ ² ¹² ¹⁵

4. Do I need a scan?

Most people with new sciatica or arm radicular pain do not need an immediate MRI or CT scan. Guidelines suggest:¹ ² ³ ¹³

• No early imaging if symptoms are typical, there are no red flags, and it has been less than about 6 weeks
• MRI when:

MRI shows disc bulges and herniations well, but these changes are also common in people with no pain, so scan results must match your symptoms and exam.² ⁵ ¹² ¹³

Clinical insight

Imaging is used when red flags are present, when symptoms do not improve, or when injections or surgery are being considered. Even then, disc findings must match the clinical picture, because disc bulges and herniations are common in people without pain.² ⁵ ¹² ¹³ The best outcomes usually come from personalised care: early reassurance and rehab for most, clear triggers for urgent imaging and surgery when needed, and thoughtful use of injections and operations rather than quick fixes.¹ ³ ⁵ ¹¹ ¹⁷

How is a herniated disc treated?

Treatment focuses on calming the irritated nerve, keeping you moving, and helping you get back to the things that matter to you. Most people start with non surgical care.¹ ³ ⁵

1. Education, reassurance, and staying active

Key points your clinician or physical therapist may stress:¹ ⁵ ⁶ ⁷

• A herniated disc and sciatica often improve over weeks to a few months
• Complete bed rest is not helpful and can slow recovery
• Gentle movement, short walks, and regular position changes are better than long periods of lying still
• It is normal to feel some discomfort during activity, but pain should settle again within a reasonable time
• Fear, worry, and bracing can make symptoms feel worse and delay recovery

Together, you can set a plan that balances activity with symptom control.

2. Exercise based rehabilitation

Physical therapy is usually a core part of care. Early on the focus is comfort. Later it shifts to building strength and confidence. A program may include:¹ ⁵ ⁶ ⁷

• Positions and repeated movements that reduce leg or arm pain (directional preference or McKenzie-type exercises)
• Trunk stabilization and endurance exercises
• Hip and shoulder girdle strengthening
• Gentle nerve gliding or “neurodynamic” techniques when appropriate
• Aerobic conditioning such as walking, cycling, or swimming

Research on sciatica specific exercise is mixed, but overall supports supervised, impairment based programs combined with education and self management rather than passive treatments alone.⁶ ⁷

3. Medications

Medicines help with symptom control, but they do not “fix” the disc. Guidelines suggest:¹ ⁵ ⁸

Short courses of:

• Non steroidal anti inflammatory drugs (NSAIDs), where safe
• Simple pain relievers such as paracetamol, though benefit may be limited

Avoid the routine use of:

• Gabapentinoids and other antiepileptics for sciatica
• Benzodiazepines
• Oral steroids for sciatica
• Long term opioids for chronic sciatica

Any medicine plan should be personalised and reviewed regularly.

4. Epidural steroid injections (ESIs)

An epidural steroid injection delivers anti inflammatory medicine around the irritated nerve root. For some people with lumbar disc related sciatica, ESIs can:⁸

• Reduce leg pain in the short to medium term
• Lower early use of strong pain medicines
• Help delay or sometimes avoid surgery

It is important to understand that ESIs:

• Do not repair the disc or change long term outcomes in a predictable way
• Often provide temporary benefit, which may fade over weeks to months
• Carry rare but serious risks, including stroke, paralysis, or vision loss⁹ ¹⁰

Because of this, injections are usually considered after a period of good rehabilitation and careful discussion of risks and benefits.¹ ⁸ ¹⁰

5. Surgery

Surgery is usually reserved for specific situations.

Lumbar microdiscectomyThis procedure removes the part of the disc that is pressing on the nerve. Studies show that for people with leg dominant pain from a disc herniation and matching MRI findings:⁵ ¹¹ ¹⁷

• Surgery can give faster relief of leg pain and disability than continued conservative care
• By 1 to 2 years, many people who did not have surgery have also improved, and average outcomes between groups are often similar
• Some people keep a longer term benefit from surgery, but this varies

Common reasons to consider surgery include:¹ ³ ⁵ ¹¹

• Severe, persistent leg pain that has not improved enough after about 6 to 12 weeks of high quality non surgical care
• Progressive or severe weakness in muscles supplied by the affected nerve
• Cauda equina syndrome, which is a surgical emergency

Decisions are made together with a spine surgeon, based on your symptoms, function, goals, scan findings, and other health conditions.

Cervical radiculopathy surgeryMost people with a herniated disc in the neck and arm pain improve within 6 to 12 weeks without surgery.³ ⁴ ¹⁴ Options for persistent or severe cases include:

• Selective cervical nerve root injections for short term relief
• Surgery such as anterior cervical discectomy and fusion (wear disc removal and vertebrae fixation so the nerve can exit spine without compression) or posterior foraminotomy (widening of the bone canal through which the nerve passes) when arm pain and disability remain high despite good conservative care, when imaging shows a clear match to nerve root compression, or when there is progressive neurologic deficit³ ⁴ ¹⁴

Cervical myelopathy (spinal cord compression) is a different condition and follows a more urgent surgical pathway.

Pain relief and self care

Alongside medical and rehab care, you can often ease symptoms with simple strategies:

• Use heat or cold packs on sore areas if they feel helpful
• Change position every 20 to 30 minutes when awake
• Try short walks rather than long periods in one posture
• Use pillows to support your legs or arms at night
• Practice relaxed breathing to help reduce muscle tension
• Work with your clinician to taper medicines as symptoms improve

If pain suddenly worsens, or you notice new weakness or red flag signs, contact a health professional promptly.¹ ¹² ¹⁵

How can I find pain relief for back pain?

Most people find relief through movement, pacing, and self-care rather than bed rest. Here are practical strategies:

• Keep moving: Gentle walking, stretching, or light chores maintain flexibility and circulation.
• Use heat for stiffness: A warm shower or heating pad can ease muscle tension.
• Watch your posture: Change positions often and support your back when sitting.
• Pace yourself: Alternate activity and rest to prevent flare-ups.
• Manage stress: Breathing, mindfulness, or relaxation techniques can reduce pain intensity.

Pain flares are common and don’t usually mean harm. If pain persists beyond a few weeks or limits your daily function, talk with a clinician for personalized guidance ^{1 2}.

Why physical therapy is foundational

Sword makes recovery easier and more accessible. You get high-quality care at home, guided by clinicians and supported by smart technology.

• Care that adapts to your progress in real time
• Licensed experts guiding every step
• Simple, non-invasive, evidence-based programs
• Proven results for pain relief, movement, and satisfaction