A herniated disc in the lower back often causes pain radiating to the buttock or leg, sometimes with tingling, numbness or loss of strength. Below you can read how a herniated disc develops, when to call a doctor straight away, what you can do yourself and how we treat you without surgery. You do not need a referral from your GP.
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What is a herniated disc?
Between the vertebrae of your back are intervertebral discs: cushions with a firm ring and a soft core. In a herniated disc, part of that core bulges out through a weak spot in the ring and presses on a nerve. The medical name is HNP (hernia nuclei pulposi). It usually involves the lowest two discs, L4-L5 and L5-S1: the L stands for lumbar vertebra, the S for the sacrum. A herniated disc in the neck also exists; it causes pain radiating to the arm.
The pain comes not only from the pressure, but also from an inflammatory reaction around the nerve. Pain radiating into the leg is also called sciatica. Not every sciatica is a herniated disc, and not every herniated disc on a scan causes symptoms: many people without back pain also show a bulge on an MRI.
Does a herniated disc go away on its own?
Usually, yes. According to Thuisarts, the symptoms ease on their own within 3 months in about 3 out of 4 people, and after a year 88 out of 100 people who wait have no symptoms anymore. The body often clears away the bulging material itself; this is called resorption. In a review of studies, the herniation had shrunk or disappeared on a second scan in about two out of three people.
What helps that recovery: staying active, carrying on with your daily activities as much as possible and, if needed, painkillers at fixed times. Lying in bed for a long time does not make you better faster. We treat to reduce the pain and get you moving again while your body recovers. We do not replace surgery that is actually needed.
When should you call a doctor straight away?
Call your GP or the out-of-hours GP service straight away if you have one or more of these symptoms:
- suddenly less strength in your leg, or no longer being able to stand on your toes or heels;
- a numb feeling around the anus and the genitals;
- no longer being able to pass urine, or no longer being able to hold your urine or stools.
These are warning signs. Then we do not treat, but refer you the same day. With these signs, every hour counts.
Hernia protocol without surgery
Our herniated disc protocol combines a few treatments. Which ones you receive depends on the examination.
- Spinal decompression: on a special table, a computer-controlled system gently and rhythmically stretches your lower back. The aim is to lower the pressure on the disc and the nerve. Research on this is limited: a Cochrane review found little effect of traction as a stand-alone treatment, and the British guideline NICE NG59 advises against traction for low back pain and sciatica. That is why we never use decompression on its own, but always together with exercises and gentle chiropractic.
- Gentle chiropractic: techniques without cracking and with little force. In the painful phase we do not make quick twisting movements of the lower back.
- Exercises for the deep abdominal and back muscles that support the spine, and a programme for at home.
- Injections by the doctor: perineural injection therapy (PIT), an injection of glucose around an irritated nerve, and for long-standing complaints prolotherapy. For both, the research is still small; the doctor will discuss with you whether it makes sense.
Chiropractic is available in Rotterdam, at Cor Kieboomplein. Decompression is available in Rotterdam and in Dordrecht. The doctor gives PIT in Dordrecht; prolotherapy in Dordrecht and on Thursdays also in Rotterdam.
Your recovery journey
Every programme is tailored. This is what a typical course looks like. After each phase we decide together whether continuing makes sense; you are not tied to a fixed series.
Consultation and examination
You tell us about your symptoms and we examine your back, your nerves and your strength. An MRI is only needed for severe or persistent symptoms, or when surgery is being considered. If one is needed and you don’t have one yet, we refer you. At the end you know what we see and whether the herniated disc protocol suits you.
Starting gently
In the first weeks you usually come three times a week for decompression and gentle chiropractic. Many people notice after 4 to 6 sessions whether the radiating pain is easing. If you notice nothing, we discuss whether continuing makes sense.
Building up
After that you come 1 to 2 times a week, with more exercises for the deep abdominal muscles and the back muscles. The whole programme often consists of 15 to 25 sessions over 6 to 10 weeks; that is advice, not an obligation.
Carrying on yourself
You get a home exercise programme. You don’t have to come back; if your symptoms return later, you are welcome.
What does it cost and what is reimbursed?
An intake with a first chiropractic treatment costs € 90, a follow-up session € 70. A first consultation with the doctor costs € 220, a follow-up consultation € 200, including any injection. How many sessions you need, you will hear after the first visit, before you commit to anything. All prices are on the rates page.
Chiropractic is (partly) reimbursed by most supplementary insurance policies, and it does not come out of your deductible. With the reimbursement check you can see what your policy covers.
What the research says
Surgery (usually a microdiscectomy in hospital) often relieves leg pain faster than waiting, but in a large Dutch study the difference had disappeared after a year. Whether surgery is worthwhile for you is a choice you make with your GP and the neurologist. Thuisarts has a decision aid for this.
The evidence for decompression and traction is weak. We prefer to say so up front: with us it is one part, alongside movement and exercise, which the guidelines do recommend.
Scientific references
Show all sourcesHide the sources
- Thuisarts. Ik wacht of mijn rug-hernia vanzelf overgaat. thuisarts.nl/rug-hernia
- Chiu CC, Chuang TY, Chang KH, et al. The probability of spontaneous regression of lumbar herniated disc: a systematic review. Clinical Rehabilitation 2015;29(2):184-195. doi: 10.1177/0269215514540919
- Wegner I, Widyahening IS, van Tulder MW, et al. Traction for low-back pain with or without sciatica. Cochrane Database of Systematic Reviews 2013;(8):CD003010. doi: 10.1002/14651858.CD003010.pub5
- NICE. Low back pain and sciatica in over 16s: assessment and management (NG59). nice.org.uk/guidance/ng59
- Peul WC, van Houwelingen HC, van den Hout WB, et al. Surgery versus prolonged conservative treatment for sciatica. New England Journal of Medicine 2007;356(22):2245-2256. doi: 10.1056/NEJMoa064039
- Brinjikji W, Luetmer PH, Comstock B, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. American Journal of Neuroradiology 2015;36(4):811-816. doi: 10.3174/ajnr.A4173
Frequently asked questions
When is surgery necessary?
Immediately with the warning signs above. Otherwise surgery can be an option if the leg pain is still severe after 6 to 12 weeks and you cannot live with it well. You make that choice with your GP and the neurologist or neurosurgeon.
Do I need an MRI?
Usually not. With mild symptoms, the examination in the practice is enough. An MRI is useful for severe or persistent symptoms, or when surgery is being considered. A bulge on a scan says little in itself: it is also seen in many people without symptoms.
Can I move and exercise with a herniated disc?
Yes, staying active helps. Walking and swimming usually go well. Heavy lifting, bending deeply with weight and jarring loads such as running are best postponed until the radiating pain has eased.
Does a hernia come back?
It can. If you have had a herniated disc before, you are more likely to get another. Exercises for the trunk muscles and staying active probably reduce that risk; there is no guarantee.
Is a chiropractor a good idea for a herniated disc?
It is possible for most herniated discs, and guidelines mention manual treatment as one of the options for persistent back pain with radiating pain. What we do depends on the examination: with an irritable nerve we work gently, not with force, with decompression as one part of the protocol. If there are warning signs, we do not treat, but refer you the same day.
Does decompression hurt?
No. It feels like a calm, rhythmic stretch in the lower back. If the pain gets worse, we stop or adjust the treatment.
Do I need a referral?
No. You make the appointment yourself; a GP referral is not needed. Are you a GP or physiotherapist and would you like to refer a patient to us? Read what you need to know as a referrer.
