Someone hands you a report that says disc bulge, degenerative change, annular fissure. You read it three times. You stop lifting anything. Six months later your back is worse, and not because of the disc.
This is one of the most consequential things we talk about with patients, so it is worth setting out properly.
The finding that changed how this should be discussed
When researchers scan the spines of people who have no back pain at all, they find disc degeneration in a large majority of people over fifty, and disc bulges in a substantial proportion of people in their thirties. The proportion rises steadily with age, in people who are completely symptom-free.
Put plainly: those findings are closer to grey hair than to injury. They describe a spine that has been used.
What that means for your report
It does not mean your pain is imaginary. It means the scan cannot tell you which of the several findings on it, if any, is producing your symptoms — and the language it uses is far more alarming than the situation usually warrants.
The clinical consequence is real and measurable: people who are told they have degeneration move less, guard more and do worse, independent of what their spine actually looks like.
When imaging genuinely matters
There are situations where a scan changes management, and your physiotherapist screens for them at the first appointment:
- Numbness around the groin or saddle area, or loss of bladder or bowel control — this one is an emergency, not an appointment
- Progressive weakness in a leg rather than pain alone
- Significant trauma — a fall from height, a car accident
- Unexplained weight loss, fever, or a history of cancer
- Symptoms that are not behaving the way a musculoskeletal problem behaves
If any of those are present, we refer you. If none are, a scan usually costs you money and confidence and buys nothing.
What we do instead
We work out what your back does — which movements provoke, which relieve, what your leg symptoms are doing, what you can currently tolerate. That gives a plan, which a scan does not.
Then hands-on treatment for comfort and, more importantly, a loading program that rebuilds capacity in your back, hips and trunk. Whether it is general low back pain, sciatica, or a genuine disc herniation, the treatment is more similar than different, and it is not rest.
One more thing about herniations
Disc herniations frequently reduce in size on repeat imaging over months, including large ones. Bodies resorb them. That is not a fringe claim; it is a well-described phenomenon, and it is rarely mentioned at the point where someone is handed a frightening report.
Most people with a herniated disc get better without surgery. It takes longer than anyone wants, and the direction of travel — leg pain receding back towards the spine — is usually visible well before the pain is gone.
Forge West End is at Unit 4, 249 Montague Road, West End. Book online or call 07 3844 0686 — we are open from 6am Monday to Friday.