Lumbar Disc Herniation - When Your Back Gives Way

Herniated Lumbar Disc?

You wake up one morning with a sharp pain radiating down your leg, and maybe some numbness and tingling leading down that same leg. Suddenly, turning over, bending down, or even walking feels like a risky activity. It could be a herniated disc - one of the most common spinal problems that can completely steal your peace of mind and limit your everyday activities. BUT.. before you resort to surgery, there's good news:

Many people recover quite well with non-invasive care options (otherwise called conservative care). Lets dig in to the research, what it actually shows about conservative treatment, and what options you have before signing off on that scary surgery.

What is a Lumbar Disc Herniation & what is it's natural course?

A herniated disc, also called a lumbar disc prolapse, or extrusion, means that the soft center (nucleus pulposus) of a spinal disc bulges or leaks out past its normal boundary. This often causes a pressure on nearby nerves that exit the spine causing pain, numbness, or weakness down the leg (radiculopathy).

Most cases improve over time: studies show how many people begin to get meaningful relief with conservative care over 4-6 weeks to 3 months, provided there are no present red flag symptoms at the time of injury (e.g. Cauda Equina Syndrome (loss of bowel or bladder function, loss of groin sensation, foot-drop, etc), and major motor deficits).

Is there evidence for Chiropractic / Spinal Manipulation?

Chiropractic spinal manipulations for the low back ("adjustments") are most commonly high-velocity, low amplitude, side posture techniques. These adjustments have been studied in people with MRI confirmed lumbar disc herniation.

One observational study noted about 70% of patients reported clinically relevant improvements in as early as 2 weeks; by 3 months, up to ~90% had improved, and those gains stabilized at 6-12 months.

Not only does manipulation seem to help with pain and function, but receiving chiropractic care early has been shown to be associated with reduced odds of needing surgery to correct the lumbar herniation (discectomy) with radiculopathy over 1 and 2 year follow ups.

What else works? What do the guidelines say?

Other than spinal manipulation, there are several non-surgical treatments shown to help: exercise therapy (especially core stabilization, flexibility, gradual loading), patient education. on posture and body mechanics, neural mobilization (nerve gliding) exercises when nerve involvement is present, and sometimes motorized spinal decompression in certain settings.

A recent narrative review (2024) in Journal of Clinical Medicine found that neural mobilization yields moderate evidence for pain reduction and disability in patients with disc herniation & radiculopathy.

Clinical practice guidelines typically recommend trying at least 6 weeks of conservative care (sometimes up to 12 weeks) before considering more aggressive or invasive options.

Is Conservative Care Safe?

One worry often voiced is: "Will spinal manipulation or non-surgical care make it worse?" Research so far suggests the risk of serious harm is very low.

A systematic review on safety of spinal manipulation in lumbar disc herniation cases found that clinically meaningful worsening (or irremediable adverse events like cauda equina syndrome) from spinal manipulation is very rare.

Also, compared to the risks associated with long-term medication or surgery, the overall safety profile for chiropractic care and other conservative therapies is favorable.

Conclusions / Recommendation

If you suspect or have been diagnosed with a lumbar disc herniation (especially of symptoms are moderate, without severe motor deficits or red-flag signs), it makes sense to explore conservative care first. Here are some evidence-based options to consider based on the research:

• Chiropractic Care - including spinal manipulation (HVLA) along with manual therapies

• Supervised Physical Therapy / Exercise Programs - focusing on core strengthening, flexibility, and a gradual return to activities of daily living

• Neural Mobilization / Nerve Gliding Techniques - if there is pain, tingling, or nerve irritation symptoms

• Motorized Spinal Decompression or Traction - in select cases, especially where imaging shows active compression, and when combined with other therapies

These approaches often reduce pain, restore function, and significantly lower the chances of needing surgery - often times at a significantly lower risk and cost. As always, each case is unique: you should consult a qualified chiropractor or conservative care provider, and its recommended that they work in conjunction with your medical doctor to develop a plan tailored to your symptoms, exam findings, imaging, and personal goals.

Disclaimer: The information in this article is for educational purposes only and is not a substitute for personalized medical advice, diagnosis, or treatment. Always consult a qualified healthcare professional for questions about your health or before starting any new treatment. Results vary by individual. In emergencies, call 911. Texas readers: ensure chiropractic services are provided by a chiropractor licensed by the Texas Board of Chiropractic Examiners.