Herniated Disc

Herniated Disc and Osteopathy

What is a Herniated Disc?

A herniated disc occurs when the nucleus pulposus of an intervertebral disc protrudes beyond its fibrous ring. The disc, positioned between two vertebrae, acts as a shock absorber and load distributor. When the annulus fibrosus develops fissures, the nucleus may bulge and compress adjacent nerve structures.

Lumbar disc herniations are the most common (L4-L5 and L5-S1 levels), though they may also occur at the cervical level. Importantly, many disc herniations are asymptomatic: their presence on imaging does not necessarily mean they are the source of pain.

Associated Symptoms

• Lumbar or cervical pain, sometimes intense
• Pain radiating into the lower limb (sciatica, cruralgia) or upper limb (cervico-brachial neuralgia)
• Tingling, numbness or loss of sensation in the affected nerve territory
• Pain worsened by coughing, sneezing or straining
• Stiffness and limitation of spinal movement
• In severe cases, muscular weakness in the affected limb

What the Research Shows

Imaging studies demonstrate that 30 to 40% of asymptomatic adults present with a disc protrusion or herniation on MRI. The presence of a herniation therefore does not automatically mean it is responsible for the pain. Clinical assessment is essential to establish the link between imaging findings and symptoms.

The majority of symptomatic disc herniations resolve favourably over a period of weeks to months. Spontaneous disc resorption is a well-documented phenomenon.

Osteopathic Approach

Osteopathy does not treat the disc herniation itself, but can act on the mechanical environment that contributes to pain:

• Restoring mobility of vertebral segments adjacent to the herniation
• Releasing protective muscular tension (psoas, quadratus lumborum, paraspinal muscles)
• Rebalancing the pelvis and sacroiliac joints
• Improving thoracic and cervical mobility to redistribute mechanical stress
• Gentle techniques prioritised, adapted to patient tolerance

The practice also has a spinal decompression table, which may be used alongside manual treatment for certain disc-related pain.

How Many Sessions?

Management is progressive. 2 to 4 sessions, spaced according to progress, generally allow assessment of treatment response. The goal is to reduce pain, restore mobility and support functional recovery.

References

• McMorland G, Suter E, Casha S, du Plessis SJ, Hurlbert RJ. (2010). Manipulation or microdiskectomy for sciatica? A prospective randomized clinical study. Journal of Manipulative and Physiological Therapeutics, 33(8):576-584. PMID 21036279
• Santilli V, Beghi E, Finucci S. (2006). Chiropractic manipulation in the treatment of acute back pain and sciatica with disc protrusion: a randomized double-blind clinical trial. The Spine Journal, 6(2):131-137. PMID 16517383

Is there treatment for a herniated disc without surgery?

Yes, and it is the usual route. The large majority of herniated discs are never operated on. Left alone with appropriate management, a herniated disc tends to shrink over time — the body reabsorbs part of it.

Conservative treatment combines pain control, staying active, physiotherapy and manual treatment. Non-surgical spinal decompression, available at the practice, can be added when the pain is persistent and clearly discogenic.

Surgery becomes the subject when a neurological deficit appears or worsens, when pain stays unmanageable despite proper treatment, or urgently in cauda equina syndrome. That decision belongs to the surgeon.

How long does it take to recover?

Recovery is measured in weeks, not days, and it is rarely linear. Good days followed by a setback do not mean the treatment has failed.

One sign matters more than pain intensity: where the pain sits. Pain retreating from the leg back towards the buttock and lower back is going the right way, even if it is still strong. Pain travelling further down the leg is not.

If nothing has shifted after several weeks, or if weakness appears, the diagnosis needs review rather than more of the same.

Which doctor should you consult?

In France you do not need a referral to see an osteopath — direct access is the norm, and no GP letter is required.

• Osteopath or physiotherapist for mechanical back pain and sciatica without neurological signs
• GP for pain relief, sick notes, and to arrange imaging when it is warranted
• Rheumatologist for persistent pain or suspected inflammatory disease
• Neurosurgeon only where there is confirmed compression with neurological consequences

Bring any imaging you already have, in any language. An MRI report reads the same everywhere.

Warning signs

Certain symptoms mean a doctor, not an osteopath, and without delay: weakness in a foot or hand, numbness around the saddle area, difficulty passing urine or controlling the bladder, fever, unexplained weight loss.