Herniated discs, often referred to as “slipped discs,” affect approximately 5 to 20 out of every 1,000 adults annually, with a higher occurrence in men compared to women (2:1 ratio). Typically, these prolapsed discs occur in individuals between 30 and 50 years old, predominantly affecting the L4-L5 and L5-S1 discs in about 95% of lumbar disc herniations.
There are four stages of herniated discs: Bulging; Protrusion; Extrusion; Sequestration (see image below)
 Bulging: extension of the disc margin beyond the margins of the adjacent vertebral endplates |  Protrusion: the posterior longitudinal ligament remains intact but the inner nuclear material impinges on the outer annular fibres |
 Extrusion: the nuclear material emerges through the annular fibres but the posterior longitudinal ligament remains intact |  Sequestration: the nuclear material emerges through the annular fibres and the posterior longitudinal ligament is disrupted. A portion of the nucleus pulposus has protruded into the epidural space |
The encouraging news is that 75% of intervertebral disc herniations naturally resolve within 6 months. Surgical intervention only becomes necessary when conservative treatments fail to yield positive results. However, in recent years, significant strides have been made to reduce the necessity for spinal surgery. According to the clinical guidelines outlined by the “National Institute for Health and Care Excellence 2016,” the initial approach leans heavily toward conservative treatments, including medication, support, advice, and exercise therapy.
Physiotherapy interventions offer a non-complicated and cost-effective alternative to surgical treatment. It serves as a frontline management approach before considering invasive surgical procedures. Therefore, prioritising evidence-based physiotherapy management for disc herniation holds immense clinical significance.
Some physiotherapy modalities that prove beneficial in managing disc herniation include:
- Stretching exercises
- Muscle strengthening
- Traditional Chinese Medicine methods such as acupressure, acupuncture, and cupping
- Spinal mobilisation techniques
- Postural re-education exercises
- Transcutaneous Electrical Nerve Stimulation (TENS)
By incorporating these physiotherapy modalities, individuals struggling with disc herniation can explore non-invasive and effective avenues for relief and recovery.
References
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Singh V, Malik M, Kaur J, Kulandaivelan S,and Punia S. “A systematic review and meta-analysis on the efficacy of physiotherapy intervention in management of lumbar prolapsed intervertebral disc.” Int J Health Sci (Qassim), 2021: 15(2): 49–57.