Can a L4/5 herniated disc improve with only physiotherapy and exercise?

Doctor's Answers 1

Photo of Dr Shee Yan Fong
Dr Shee Yan Fong

Orthopaedic Surgeon

Depending on the severity/size (or Stage) of your disc herniation in both your clinical signs and in your MRI, Stage 3 (large, severe) slipped disc must undergo surgery to improve no other choice !

Early Stage 1 (small, mild) and Mid Stage 2 (moderate disc bulge) can be "managed" by physical therapy whenever it "acts up" but without surgery cannot be permanently "cured".

As long as it doesn't escalate to Stage 3 or affect your quality of life/work, we can live with it with on-off treatment for relapses as long as physical therapy still helps, is non-invasive and can be repeated multiple times (unlike surgery).

In principle, low or non-impact "horizontal" exercises (swimming, yoga, etc) are safer for your lower back. You don't want high impact "vertical" exercises (running, racket games, etc) to stress your worn out L4-5 disc further !

Similar Questions

How do I treat a bulging disc that is causing lower back pain?

Thank you for your email. I agree with what Dr Chung or Dr Dinesh have said. It is an extremely common problem seen in people, whether young or old. First line of treatment is always medication and physiotherapy to strengthen the core and paraspinal muscles. If that does not work, and the pain is persistent, and if MRI does show a disc bulge and/ or annular tear, another option that you may want to consider is a nucleoplasty, annuloplasty and facet block of the affected levels. It works very well, and may patients do find symptomatic relief.

Photo of Dr Sean Ng

Answered By

Dr Sean Ng

Orthopaedic Surgeon

How can I get rid of persistent back pain that is not responding to physiotherapy?

Thank you for your email and I am sorry to hear about your ongoing pain symptoms. This can be an issue after surgery even if it does resolve the disc issue/symptoms that you were experiencing. The only way to resolve pain is to assess you and consider the pain generators in the back - unfortunately there can be many. It could be residual pain from degenerative discs, facet joints, nerve irritation, muscular tightness, scar tissue formation and so on.

Photo of Dr Dinesh Sirisena

Answered By

Dr Dinesh Sirisena

Sport Medicine

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