Problem
Disc protrusion and herniation
Putting the MRI scan into context.
An MRI scan showing ‘protrusion’ or ‘hernia’ can be quite alarming.
This is important information.
To understand what this means for you, you need to consider it alongside what you’re experiencing and how you move.
The image is important, but it needs context
Imaging studies show degenerative changes and protrusions even in people without pain, and their frequency increases with age.
The MRI scan is just one piece of the puzzle. To interpret it, I need to relate it to:
- where it hurts
- if there is a loss of strength
- sensitivity
- distribution of pain
- movements that alleviate symptoms
- actual function.
I don’t try to ‘push the disc back into place’
Manual therapy does not reposition a hernia.
The aim of conservative treatment is to reduce symptoms, restore movement and function, and improve load tolerance where the condition allows for a non-surgical approach.
A disc protrusion does not necessarily mean radicular pain
A disc protrusion may be significant or may occur without being the cause of your symptoms.
The important thing is to check how this matches what you’re experiencing.
What if I have an L5-S1 herniated disc?
L5-S1 is a common site.
A posterolateral herniation at that level may affect the S1 nerve root.
A typical presentation may include pain radiating from the buttock down the back of the leg and into the lateral or plantar region of the foot, as well as possible changes in muscle strength or reflexes.
The big toe and the instep of the foot are more commonly associated with an L5 pattern than with an S1 pattern.
The location of the pain provides a guide, but we need to check how this fits in with what you’re experiencing, how you move and how your body responds.
How I work
Depending on what we find, we can assess:
- lumbar
- pelvis
- hip
- neural mobility
- muscles
- function and load.
Treatment may combine manual therapy with a progressive active phase.
The aim
Let the MRI scan be just a piece of information, not your entire physical identity.
The MRI scan shows the disc. The treatment needs to be tailored to you.
Sources and further reading
To find out more
References that expand on the points discussed.
View sources
- Brinjikji W et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations · View source
- Brinjikji W et al. MRI findings of disc degeneration are more prevalent in adults with low back pain than in asymptomatic controls · View source