Back Pain Doctor
Lumbar Disc Herniation
Written by Dr Joshua Hatch, Musculoskeletal GP, RACGP Fellow, Diploma in Musculoskeletal Medicine (FSEM UK).
A herniated disc—sometimes called a “slipped disc”, although nothing literally slips—happens when disc material pushes out beyond its usual boundary. This can develop gradually or become symptomatic during lifting, bending or twisting. When the herniation irritates or compresses a nearby nerve root, it can cause leg pain (sciatica) as well as back pain. A broader “bulging disc” on a scan is not necessarily the same thing and is commonly found in people without pain; see the plain-English guide to slipped and bulging discs.
The reassuring reality is that most lumbar disc herniations improve with time and sensible activity. Staying as active as your symptoms allow, avoiding prolonged bed rest, physiotherapy and simple pain management are the foundations of recovery. In many cases the herniation shrinks on its own over the following months.
Our role is to assess your symptoms carefully, check for any features that need further investigation or referral, and give you an honest plan. Where pain is limiting, we can discuss reasonable options to help you stay comfortable and active while the disc settles — always alongside, not instead of, good rehabilitation — and we are clear about when a surgical opinion is and is not warranted.
Common symptoms
- Lower back pain, often the first symptom, which may then ease
- Sciatica — sharp or shooting pain travelling from the buttock down one leg
- Pins and needles or numbness in the leg or foot
- Leg weakness, or pain aggravated by bending, lifting or twisting
Commonly seen in
Evidence for twelve treatment options in lumbar disc herniation
This is not a fixed ladder or a package of treatments. Every option is assessed independently against this diagnosis, including treatments with limited direct research that may still be reasonable for a clearly defined tissue target. The evidence level, likely benefit, risks, cost and alternatives are weighed at consultation.
Foundation — diagnosis, education and rehabilitation
The part of care with the broadest relevance. For many people it is enough on its own; other options are judged against it, not automatically added after it.
Diagnosis, education and progressive rehabilitation Working out what is driving the pain, explaining what your imaging does and does not mean, and building a graded loading plan you can actually follow. Core care
What it involves
Assessment to identify the likely pain source, an explanation of what the diagnosis means, adjustment of the loads that aggravate it, and a progressive strength and conditioning plan — with weight management where that is clinically relevant.
What the evidence shows
Every high-quality guideline says the same thing. The American College of Physicians makes a strong recommendation that chronic low back pain be treated first with exercise and multidisciplinary rehabilitation rather than drugs or procedures (Qaseem, Ann Intern Med 2017). An overview of 15 primary-care guidelines found consistent agreement on education, staying active, exercise and reassurance, and on discouraging routine imaging (Oliveira, Eur Spine J 2018). For neck pain the strongest effects also belong to exercise, with strengthening of the neck and upper quadrant showing a moderate short-term effect (Sterling, J Clin Med 2019). Adding pain-science education to exercise improves pain, disability and fear of movement over exercise alone (Bonatesta, J Pain 2021).
Pairing reviewed 2026-09-02.
Where it fits for you
Understanding why the back hurts, and moving well, does more than anything injected. Imaging is used to answer a specific question, not as a starting point — degenerative findings are near universal and frequently unrelated to the pain.
Muscle and symptom-modifying options
Useful only when the examination identifies the tissue they target or when short-term pain control creates a useful rehabilitation window.
Wet needling and trigger point injection (trigger point injection) A fine needle into a tender band of muscle, with a small volume of dilute glucose solution injected through it. Worth discussing
What it involves
The needle is placed into the tender muscle band and a small volume of 5% glucose with 0.02-0.08% lignocaine is injected. Often done in the same visit as your assessment, and usable where the tender area sits deeper. Dry needling — the same technique with nothing injected — is not offered here.
What the evidence shows
Needling aimed at myofascial trigger points has been tested in this condition. A randomised trial of 100 people with lumbar disc herniation found trigger-point-directed needling improved pain, lumbar range of movement and quality of life more than standard acupuncture, and reduced the number of tender points in quadratus lumborum, multifidus and iliocostalis (Li, Zhen Ci Yan Jiu 2024). That trial used a needling technique rather than an injection, and the largest trial of trigger point injection in low back pain — 180 people, three arms — found no benefit over standard care at all (Lajeunesse, Ann Emerg Med 2025). Nothing has tested 5% glucose here.
Pairing reviewed 2026-09-07.
Where it fits for you
Aimed at the paraspinal or gluteal muscle that has tightened around the problem, not at the disc. Considered alongside the loading programme where examination finds a tender band that reproduces part of your pain.
Ultrasound-guided injections Guidance means we can see the needle reach the target. What goes into the needle depends on the diagnosis. Small, short-term effect
What it involves
The injection is performed under ultrasound so the needle can be watched into the target structure. What is injected is decided by the diagnosis — and corticosteroid is used sparingly, for the reasons set out below.
What the evidence shows
The evidence belongs to epidural corticosteroid injection placed under X-ray or CT, not to an ultrasound-guided injection. Across 25 placebo-controlled randomised trials in 2,470 people with disc-related leg pain, epidural corticosteroid probably beat a placebo injection on short-term leg pain by 4.9 points on a 0 to 100 scale (95% CI -8.8 to -1.1) and on disability by 4.2 points (-6.0 to -2.2), at moderate quality (Oliveira, Spine 2020). The American Academy of Neurology review of 90 randomised trials reports about one extra person helped for every four treated for short-term pain and one in six for short-term disability, with insufficient evidence on long-term pain (Armon, Neurology 2025). Adverse events were mostly minor and no more common than after a placebo injection. Nothing in this literature shows an injection changes what the disc does; most herniations resorb regardless.
Pairing reviewed 2026-09-17.
Where it fits for you
Not performed here, and not a substitute for the loading and education that carry the evidence. Where leg pain is severe or persistent, this is a referral conversation about an X-ray or CT-guided epidural, weighed against the natural history — most disc-related leg pain settles with time. New or progressive weakness, numbness or bladder change needs assessment rather than an injection. See the note on cortisone.
V-ACTOR vibration therapy (vibration therapy) Low-frequency vibration applied over tender muscle. Not a shockwave, despite sharing the machine. Plausible — no studies
What it involves
A vibration handpiece is moved over the tender muscle and fascia for a few minutes. It runs from the same STORZ MASTERPULS icon console as radial shockwave but is a separate handpiece delivering a different, gentler form of energy. No needles, no anaesthetic, no downtime.
What the evidence shows
No published clinical trial of this device in this condition. It is a vibration handpiece delivered from the same console as radial shockwave, and the rationale is myofascial rather than tendon- or bone-directed.
Pairing reviewed 2026-08-30.
Where it fits for you
A comfort measure used within a session where muscular tightness is limiting movement. Never the reason for the appointment, and not a substitute for the treatments that do have evidence.
Energy-based treatment options
Radial pressure wave, focused shockwave and EMTT have different targets and different evidence. They are assessed separately rather than treated as one category.
Radial or focused shockwave? Read the overviewRadial shockwave (radial pressure wave) Broad treatment across tender muscle and fascia, close to the surface. Not for the disc
What it involves
A handpiece is moved over the tender tissue while ballistic pressure pulses are delivered, using a transmitter head chosen for the tissue — including heads shaped for fascia and for the muscle either side of the spine. The pulse is strongest at the skin and weakens with depth, so this is mainly a myofascial treatment, though it can reach deeper in some areas. No anaesthetic, no downtime, usually a course of sessions about a week apart.
What the evidence shows
A tested absence: a search pairing lumbar disc herniation, disc herniation, sciatica and radiculopathy with shockwave, shock wave and ESWT returned nine records, none of them a trial of shockwave in disc herniation. The nearest human reports are a single adolescent treated with a multimodal chiropractic protocol that included shockwave (Chu, Cureus 2025) and a randomised trial in piriformis syndrome, which is a muscle problem outside the spine (Dede, Turk J Phys Med Rehabil 2026). The meta-analyses showing short-term benefit from shockwave in low back pain are all in non-specific back pain rather than in disc herniation (22 studies, 1,749 patients: pain -1.14, 95% CI -1.47 to -0.80) (Wu, Medicine 2023).
Pairing reviewed 2026-09-13.
Where it fits for you
Not a treatment for the disc or for a compressed nerve root. Offered only for the tender paraspinal and gluteal muscle that often accompanies a disc problem, and only once the leg symptoms are being managed on their own terms.
Focused shockwave (ESWT) A true shock wave converging at depth — for tendon, joint, ligament and bone. Only if relevant
What it involves
A focused system generates an acoustic shock wave that converges at a focal point set at a defined depth, concentrating the energy where the target is. This is the form we use for tendon, joint, ligament and bone. Typically four to six sessions about a week apart, no anaesthetic and no formal downtime.
What the evidence shows
Focused shockwave is not aimed at a disc, a facet joint or a nerve root, and there is no trial evidence for it in these conditions.
Pairing reviewed 2026-08-30.
Where it fits for you
Considered only where examination finds a separate tender muscle or tendon contributing to the pain.
EMTT (magnetotransduction therapy) High-energy magnetic pulses applied over the area. Painless, no contact. Plausible — no studies
What it involves
You sit with the applicator positioned over the area for a short session. Painless, no gel or contact required, and usually delivered as a course — commonly alongside shockwave.
What the evidence shows
There are no published randomised trials of EMTT in this condition, or in any musculoskeletal condition, that we can point to. The supporting work is laboratory work: EMTT increased tenocyte proliferation, migration and collagen expression in cultured human tendon cells (Mancini, Int J Mol Sci 2025). The nearest human evidence for a related electromagnetic therapy is negative — a randomised trial of pulsed electromagnetic field therapy added to eccentric exercise for Achilles tendinopathy found no improvement in outcome scores or tendon neovascularity over eccentric exercise alone (Ko, Orthop J Sports Med 2024).
Pairing reviewed 2026-08-30.
Where it fits for you
Offered only as an adjunct alongside treatment that does have evidence, never as the plan itself, and only after that gap is explained. Much of the EMTT literature is manufacturer-affiliated, which is part of why we describe it this way.
Biologic and joint injection options
Each injection is assessed independently for the named diagnosis. Cost, uncertainty, likely benefit, risks and alternatives are part of the decision.
Platelet-rich plasma (PRP) Your own blood, concentrated and injected under ultrasound guidance. Evidence mixed
What it involves
Blood is taken from your arm, spun to concentrate the platelets, and injected into the target under ultrasound guidance in the same appointment.
What the evidence shows
Tested for the leg pain of a lumbar disc herniation as an injection beside the affected nerve root, always against cortisone and never against a dummy injection. The largest trial gave 124 people an ultrasound-guided injection of PRP or cortisone and found no difference in pain, disability or nerve testing at any point over twelve months, with no complications in either group (Xu, Neural Plast 2021). The smaller trials show a pattern rather than a winner, with cortisone ahead in the first weeks and PRP ahead later: at six and twelve weeks in a trial of 107 (Sonkar, J Clin Orthop Trauma 2026), at six months in a trial of 60 (Saraf, Indian J Orthop 2023), and at six weeks and six months in a trial of 46 that found no difference at one year, by which time 16 people in the PRP group and 17 in the cortisone group had gone on to a repeat injection or surgery (Gupta, Asian Spine J 2024). Pooling seven studies and 416 people, cortisone gave better function at four weeks (standardised difference 0.48, 95% CI 0.20 to 0.75) and nothing separated the two at any later point (Wang, J Orthop Surg Res 2025). PRP into the disc itself is a different procedure, tested for back pain rather than leg pain, and was no better than saline at twelve months in the largest trial, with one disc infection (Schepers, Interv Pain Med 2022).
Pairing reviewed 2026-10-11.
Where it fits for you
Not offered here: PRP is not injected into a disc or beside a nerve root in this clinic. Where leg pain from a disc herniation has not settled, an image-guided injection beside the nerve root is a referral conversation with a radiologist or pain medicine specialist, and on these trials PRP is an alternative to cortisone there rather than a clear improvement on it. Most disc-related leg pain eases over weeks to months, and the rehabilitation program is what carries people through that time.
Prolotherapy (dextrose) A course of dextrose injections into and around the structure and its attachments. Evidence mixed
What it involves
Hypertonic dextrose is injected at the tender ligament and tendon attachments, and into the joint where relevant, usually as a series of treatments a few weeks apart.
What the evidence shows
Prolotherapy has been studied in disc-related back and leg pain and the results conflict. A 2026 systematic review of twelve studies reported pain relief lasting six to twenty-four months, but only three of the twelve were randomised (Nazwar, J Anaesthesiol Clin Pharmacol 2026). Against that, an American Pain Society evidence review concluded prolotherapy is not effective for low back pain (Chou, Spine 2009), and the single randomised trial of epidural prolotherapy showed no benefit beyond forty-eight hours (Desai, Pain Practice 2020).
Pairing reviewed 2026-09-05.
Where it fits for you
Not directed at the disc itself and not a way to shrink a herniation. Considered only for ligament and attachment pain that persists after core care, once the leg symptoms have settled.
Viscosupplementation (hyaluronic acid) A gel-like injection into an arthritic joint. Widely used, and genuinely contested. Not used here
What it involves
One or a short series of hyaluronic acid injections into the joint under ultrasound guidance.
What the evidence shows
Hyaluronic acid has been put into a lumbar disc, but as the carrier for something else. In trials of intradiscal stem-cell injection it is the fluid the cells are suspended in and one of the comparison arms, not the treatment being tested — 100 people in the first (Amirdelfan, Spine J 2020) and 404 in a larger trial whose main measure of success was not met (Beall, Spine J 2025). Its other use is as an additive to a nerve root block, where in 44 people it reduced the flare of pain in the first fortnight but made no difference by six weeks or to function (Ko, Spine J 2018). Neither is lubrication of a joint.
Pairing reviewed 2026-09-20.
Where it fits for you
Not offered for this problem. A disc is not a joint that can be lubricated, and most herniations settle without any injection.
Nerve-targeted options
Relevant when examination identifies a superficial neuropathic pattern or a compressed peripheral nerve—not simply because pain is present.
Lyftogt perineural therapy (perineural injection therapy) A series of small dilute dextrose injections just under the skin, over tender superficial nerves. Only if relevant
What it involves
Small injections of low-concentration dextrose, usually 5%, placed just beneath the skin along tender superficial nerves. Given as a series of short sessions.
What the evidence shows
The dextrose nerve evidence is in peripheral entrapment — carpal tunnel and cubital tunnel — not in nerve root compression from the spine.
Pairing reviewed 2026-08-30.
Where it fits for you
Not a treatment for a compressed nerve root. Considered only where a separate peripheral entrapment is also present.
Ultrasound-guided nerve hydrodissection Fluid placed around a nerve to free it from the surrounding tissue. Only if relevant
What it involves
Under ultrasound, fluid is placed in the plane around the nerve to separate it from the tissue that is tethering or compressing it.
What the evidence shows
The dextrose nerve evidence is in peripheral entrapment — carpal tunnel and cubital tunnel — not in nerve root compression from the spine.
Pairing reviewed 2026-08-30.
Where it fits for you
Not a treatment for a compressed nerve root. Considered only where a separate peripheral entrapment is also present.
This is general information only and suitability is assessed individually. Treatments with limited or condition-dependent evidence may still be discussed, but only with clear explanation of the uncertainty, the expected benefit, risks, cost and alternatives. Red flags, progressive neurological symptoms or suspected serious pathology require a different pathway.
Every treatment above is described in full on the non-surgical treatments page, including what each one is used for and what the evidence supports. Ratings apply to the named diagnosis; an adjacent muscle, tendon, joint or nerve problem is assessed as a separate target. The method behind the ratings, and the treatments we do not offer, are set out on the evidence page.
Corticosteroid injection is reviewed separately for each diagnosis.
Cortisone reliably reduces pain in the short term, and that can be genuinely useful when pain is stopping you sleeping or moving enough to rehabilitate. Beyond that window the picture changes. A systematic review of 41 randomised trials and 2,672 participants found that corticosteroid injection reduced pain in the short term but that the effect reversed at intermediate and long term; in pooled analysis for lateral epicondylalgia the short-term effect was large (SMD 1.44, 95% CI 1.17 to 1.71) while no intervention was favoured at 26 weeks (-0.40, -0.67 to -0.14) and at 52 weeks (-0.31, -0.61 to -0.01) (Coombes, Lancet 2010). In a randomised trial in lateral epicondylalgia, 83 per cent of the corticosteroid group had completely recovered or much improved at one year against 96 per cent given a placebo injection, and recurrence ran at 54 per cent against 12 per cent; adding physiotherapy made no significant difference at one year (Coombes, JAMA 2013). In joints, repeated corticosteroid injections have been associated with cartilage loss. It does not repair anything.
So we do not build treatment plans around it. Where an injection is the right call, we review the specific diagnosis and target, discuss what is being injected and why, keep the number low, and pair it with the loading work that changes the longer-term course.
When we would still consider it
- Pain severe enough to block rehabilitation
- A clear inflammatory or bursal target on imaging
- A specific short-term goal — a trip, a procedure, a return to work
- Diagnostic use, where the response tells us where the pain is coming from
When a cortisone injection is worth doing, and when it is not
Other back conditions
Pain in the same area can come from more than one source, and the label matters less than what the examination and history point to. These are the other guides for this region.
Related articles
Shorter articles that answer the questions patients ask most often about this.
Frequently asked questions
Will a herniated disc heal without surgery?
When is a herniated disc an emergency?
Is a herniated disc the same as a slipped or bulging disc?
Do I need a scan or surgery?
Ready for a clearer plan for your back or musculoskeletal pain?
Book an assessment with Dr Joshua Hatch.
Your assessment focuses on understanding the likely source of your pain and the most appropriate non-surgical options for your diagnosis, with the aim of reducing pain and improving function.
Book an appointment