Disc Herniation
A disc herniation diagnosis lands hard. Surgery, recovery, months off work — those are the thoughts that arrive immediately. But current research tells a different story: the vast majority of disc herniations resolve with conservative care — no surgical intervention required. What matters is getting the right treatment started early enough. At our practice in Munich-Bogenhausen, we offer direct access — no referral, no waiting list — and a specialised motorised flexion-distraction table that provides targeted decompression of the affected disc. Let's look at what's actually happening, and what can be done.
What Exactly Is a Disc Herniation?
The Terminology Explained
Many patients arrive with a diagnosis on paper and no real understanding of what is happening in their spine. Here is what it actually means.
Disc Bulge (Protrusion)
The soft inner core of the disc (nucleus pulposus) pushes against the outer fibrous ring (annulus fibrosus), causing it to bulge outward — without breaking through. The outer wall remains intact. A protrusion is the most common form and generally the most responsive to conservative treatment.
Disc Herniation (Prolapse)
The fibrous ring tears. Disc material escapes and can press on adjacent nerves. This is what most people mean by "slipped disc" — although the disc doesn't actually slip anywhere. Depending on location and extent, this produces local pain, radiating symptoms, or neurological signs.
Sequestration
A fragment of the extruded disc material breaks completely free and lies loose within the spinal canal. It sounds serious — and can be. But sequestrated disc material also shows the highest rates of spontaneous resorption: a narrative review (Zeng et al., Spine Surgery and Related Research, 2024, PMC11165499) reports a spontaneous regression rate of 96% for sequestration. The immune system identifies the free fragment as foreign tissue and actively resorbs it.
Degeneration, Arthrosis, and Inflammation — What's the Difference?
Degeneration is a natural ageing process. After the age of 35, degenerative disc changes are visible on imaging in the majority of the population — water loss, height reduction, altered MRI signal intensity. This is normal. Degenerative findings on MRI alone are not a reason for surgery, and they do not predict pain.
Arthrosis refers to wear of the small facet joints of the spine — not the disc itself, though both often occur together.
Inflammation is frequently the actual driver of pain in disc herniation. Extruded disc material contains pro-inflammatory substances — including phospholipase A2 and cytokines — that irritate nerve tissue even without direct mechanical compression. This explains why a small herniation sometimes causes more pain than a large one.
Disc Herniation vs. Rheumatic Disease
This distinction matters. Disc herniations are mechanical in origin — caused by loading, ageing, or trauma. Rheumatic conditions such as ankylosing spondylitis (AS) or rheumatoid arthritis have an immunological cause, typically affect multiple joints simultaneously, follow a symmetrical pattern, and require an entirely different treatment approach. If back pain is accompanied by morning stiffness lasting more than 30 minutes, elevated inflammatory markers, swelling in other joints, or gradual onset before age 40, a rheumatological evaluation is appropriate. We can help recognise these patterns and refer you appropriately.
How Do I Recognise a Disc Herniation?
You have back or neck pain. But how do you know whether it's a disc herniation — or a muscle spasm, a facet joint problem, or something else entirely? Here are the patterns we look for.
Symptoms of Lumbar Disc Herniation (Lower Back)
Lumbar herniation — most commonly at L4/L5 and L5/S1 (Stretanski, Hu & Mesfin, StatPearls, updated 2025) — typically produces:
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Deep, often one-sided lower back pain
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Radiation into the buttock, thigh, calf, or foot — commonly labelled sciatica
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Tingling, numbness, or weakness in the leg
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Pain that worsens with sitting, coughing, or sneezing
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Relief in certain lying positions
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In severe cases: bladder or bowel dysfunction (see red flags below)
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In mild cases: no symptoms at all.
Symptoms of Cervical Disc Herniation (Neck)
Cervical herniations — most often at C5/C6 or C6/C7 — produce a different picture:
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Neck pain, often one-sided
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Radiation into the shoulder, arm, hand, or individual fingers
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Tingling or numbness in the arm — but critically: arm pain has many causes. A disc herniation is one of them, not the only one. Shoulder pathology, thoracic outlet syndrome, carpal tunnel syndrome, and myofascial trigger points all produce similar patterns. A thorough differential diagnosis is essential — and arm pain alone is not a diagnosis of cervical disc herniation.
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Weakness of grip
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In severe cases: gait disturbance, coordination problems (myelopathy — requires urgent medical assessment)
Can I Diagnose a Disc Herniation Myself?
Not with certainty. What you can observe at home: does pain or tingling radiate down a leg or arm? Does it worsen when coughing, sneezing, or sitting? Is there weakness in a limb? These patterns are suggestive — but not a substitute for a clinical examination.
How Is a Disc Herniation Diagnosed?
An MRI is the diagnostic gold standard for disc herniations. However, there are a number of physical and neurological tests that can be done in-office to correlate your symptoms to a strong diagnosis. At our practice, every first appointment begins with a detailed history and a full clinical-neurological examination: reflexes, strength, sensation, range of motion, orthopaedic provocation tests. If an MRI is already available, we review the findings together and explain what they mean in plain language. If imaging hasn't been done and we consider it necessary for treatment planning, we refer you to a radiologist directly.
Red Flags — Seek Emergency Care Immediately If:
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You lose control of your bladder or bowel (cauda equina syndrome — a surgical emergency)
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You develop rapidly progressive weakness in a leg or arm, or inability to control the muscles in your ankle or hand
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Disc symptoms appeared after a significant trauma
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Severe pain is accompanied by fever (possible infection or abscess)
Disc Herniation — What to Do Acutely
What actually helps
Movement beats bed rest. The single most important point: complete rest beyond one to two days worsens most disc herniations. The question is not rest vs. activity — it's which activity, how much, and when. Controlled, pain-adapted movement supports healing. Nerves recover faster when the surrounding tissues are well-perfused and mobile.
Finding a comfortable position. Some patients tolerate lying on their back with knees slightly bent; others prefer side-lying with a pillow between the knees. There is no universally correct sleeping position for disc herniation — only positions that are better or worse for your specific presentation.
Heat or cold? In the acute phase, cold packs (15–20 minutes, never directly on the skin) help when pain is inflammatory, sharp, and hot. Heat relaxes the paraspinal muscles and is more appropriate for chronic, tension-driven pain.
Which pain relief?
Anti-inflammatory medications such as ibuprofen or diclofenac can reduce the inflammatory response around the nerve and provide relief short-term. They do not heal the disc — but they can break the cycle of pain, guarding, and muscle spasm, making movement possible again. Corticosteroids — oral or injected — may be used by your physician to rapidly suppress severe nerve inflammation. Important: an injection into the spine does not prevent chiropractic adjustment of other regions of the body.
What to avoid:
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Sudden rotational movements or forceful forward bending in the acute phase
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Prolonged sitting without regular movement breaks
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Ignoring worsening neurological symptoms (numbness, weakness)
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Forceful self-stretching without knowing the underlying cause
What Causes a Disc Herniation?
The spinal disc
The intervertebral discs act as shock absorbers between the vertebral bodies. When the soft inner core pushes through the outer fibrous ring, it can compress adjacent nerve roots or, in severe cases, the spinal cord itself. The result: pain, radiation into limbs, and — in advanced cases — motor and sensory deficits.
Why does it happen?
Disc herniations rarely result from a single event. In most cases, it is a combination of:
Age-related degeneration. After 35, discs progressively lose water content and elasticity. This is normal — and does not necessarily cause pain or require treatment. Degenerative changes on MRI are present in the majority of the population over 40, including people with no symptoms at all. Degeneration alone is not a surgical indication.
Mechanical overload. Prolonged sitting, asymmetrical loading, poor workplace ergonomics, and a weak core musculature increase intradiscal pressure chronically.
Acute trauma. Lifting with rotation, a fall, or an accident can rupture an already-stressed annulus fibrosus.
Smoking. Smoking impairs vascular supply to the discs and accelerates degeneration — an underappreciated risk factor.
Who gets disc herniations?
Most commonly adults between 30 and 50 years, with a peak in mid-career. Men are slightly more affected than women. Sedentary occupations, heavy physical labour, and genetic factors all contribute.
The good news: many disc herniations resolve on their own
This is well-documented in the literature. Spontaneous healing rates of 96% for sequestration, 70% for extrusion, 41% for protrusion, and 13% for disc bulge have been reported (Zeng et al., 2024). Complete resolution occurs in 43% of sequestrated discs and 15% of extruded discs. The goal of conservative treatment is to create the conditions for this natural healing — and to support it actively.
In fact, many people have disc herniations and disc protrusions and don't even know it. According to Jordan J. et al, between 19–27% of people without any symptoms show disc herniation on imaging. In other words, a finding on MRI is not automatically the cause of pain — and does not automatically require treatment.
How Does a Chiropractor Treat Disc Herniation in Munich?
Not every disc herniation is suitable for chiropractic treatment — which is exactly why a thorough first examination is the most important step. Where there is no absolute surgical indication — no cauda equina syndrome, no rapidly progressive neurological deficit, no canal compromise exceeding one-third — chiropractic care can make a meaningful contribution to recovery.
The evidence supports this. Lilly, Davison et al. (Global Spine Journal, 2021, PMID 32677528) demonstrated in a large retrospective cohort study that the majority of lumbar disc herniation patients can be successfully managed without surgery. When conservative treatment fails, the independent predictors identified were male sex and prior opioid use — not the size of the herniation alone.
Our approach — three treatment phases
Phase 1: Reduce pressure, restore movement
The primary goal in the acute phase is to decompress the irritated nerve and restore functional mobility. We use two core tools:
Motorised flexion-distraction table (Cox technique)
Our specialised motorised flexion-distraction table is a central tool in the treatment of lumbar disc herniations. The table applies controlled flexion and distraction to the lower spine — a gentle, rhythmic traction movement that reduces intradiscal pressure, decompresses the spinal canal, and creates space for the nerve root. A meta-analysis (Wang et al., Computational and Mathematical Methods in Medicine, 2022, PMC9239808) confirmed that mechanical traction as physical therapy for lumbar disc herniation significantly reduces pain and improves function — with superior short-term outcomes compared to conventional physiotherapy. Treatment on this table is passive, controlled, and well-tolerated by virtually all patients — including those with larger herniations or complex comorbidities.
Targeted mobilisation and adjustment of adjacent segments
When a disc is irritated, the surrounding spinal segments respond with protective mechanisms: muscles tighten, joints restrict, and range of motion decreases. This is a normal physiological response — but it maintains the region in a cycle of immobility and heightened inflammation.
Chiropractic treatment aims to improve this environment — not to "fix" the disc directly. Through gentle mobilisation and specific adjustment of adjacent vertebral segments, movement is restored. When people move better, they heal faster. That's not a slogan — it's physiology.
An important clarification: Chiropractic adjustment does not cause disc herniations. It does not add damage to a disc that isn't already there. Treatment is directed at the adjacent, non-acutely affected segments — and at the overall system that either enables or impedes healing.
Phase 2: Supporting neurological recovery
As acute pain subsides, the real rehabilitation work begins. Nerves recover slowly — sometimes over weeks to months, depending on the degree of compression. In this phase, we:
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Monitor neurological function regularly (reflexes, strength, sensation)
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Introduce movement therapy specifically calibrated to the affected spinal region and neurological pattern
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Apply DNS (Dynamic Neuromuscular Stabilization) techniques to progressively rebuild neuromuscular control of the deep trunk stabilisers
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Guide the transition from passive decompression to active load tolerance
If you are being concurrently treated by an orthopaedic specialist, neurologist, or pain physician — including with injections or medication — this is not a barrier to chiropractic care. Chiropractic treatment complements pharmacological management. An injection into the spine does not prevent chiropractic adjustment of other body regions. We work as part of your care team, not in competition with it.
Phase 3: Building resilience, preventing recurrence
Pain relief is not the end of treatment — it is the beginning of prevention. The most common cause of recurrent disc herniations is an inadequately rehabilitated trunk musculature. In this phase, we develop with you a specific exercise programme that:
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Builds the deep segmental stabilisers (multifidus, transversus abdominis) systematically
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Corrects movement patterns that contributed to the original overload
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Is calibrated to your daily life — whether office work, manual labour, competitive sport, or an active retirement
When is surgery necessary?
When a disc herniation occupies more than one-third of the spinal canal, a surgical consultation is part of a sensible team approach — not because surgery is the default, but because the patient should be monitored by a specialist in case conservative therapy is insufficient. This means: we don't recommend surgery — we ensure you are properly supported if the situation develops that way. Rapidly progressive paralysis, cauda equina syndrome, and persistent severe neurological deficits without improvement after adequate conservative therapy are the primary surgical indications (Stretanski, Hu & Mesfin, StatPearls, 2025).
Many patients with disc herniation achieve excellent outcomes with chiropractic care — without surgery, without long waiting lists, without the risks of an operation.
Disc Herniation Exercises — What Helps and What Doesn't
Movement is medicine. But the wrong exercises at the wrong time make symptoms worse. We don't give generic exercise lists — we give you a programme matched to your specific presentation.
What is often helpful early on (for the low back):
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Knee-to-chest pull while laying on the back (gently, without pain provocation)
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Cobra position, as it is known in yoga
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Pelvic floor activation in back-lying with knees bent (deep stabiliser engagement)
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Short, regular walks — several times daily, pain-adapted
What to avoid with disc herniation:
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Deep forward bending with straight knees (Valsalva effect on the disc)
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Forceful trunk rotation in the acute phase
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Sit-ups or crunches in the first weeks
When can I return to sport? When can I return to work? This depends on the extent of the herniation, the neurological picture, and the individual healing trajectory. In general: light physical activity early — heavy loading only once stabilisation is established. We discuss this openly and realistically with you.
When to See a Chiropractor for Disc Herniation
You do not need a referral to see your chiropractor. We are directly accessible — same-week appointments in Munich-Bogenhausen. No prior orthopaedic visit required, no MRI, no waiting list.
Come and see us if:
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You have a diagnosis of disc herniation and are looking for a conservative alternative to pain medication or surgery
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You have had back or neck pain with radiation into an arm or leg for more than two to three days
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You have an MRI and would like to understand what it means and what your options are
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Physiotherapy alone has not produced sufficient progress
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You are being concurrently treated by an orthopaedic specialist or pain physician and want additional chiropractic support
When to go to hospital: Cauda equina syndrome (bladder or bowel dysfunction), rapidly progressive paralysis, or severe pain following trauma require immediate emergency assessment — don't wait.
FAQ — Frequently Asked Questions About Disc Herniation
How long does a disc herniation take to resolve?
Most patients experience significant symptom improvement within 6 to 12 weeks (WFNS Spine Committee consensus, 2024). Complete structural regression of the herniation — visible on MRI — may take 3 to 6 months (Xie et al., Orthopedic Reviews, 2024). Sequestrated discs often regress faster than simple protrusions. Targeted conservative treatment actively supports this process.
Can a disc herniation heal completely?
Yes — in many patients, particularly with sequestration and extrusion. Spontaneous regression rates of up to 96% have been documented for sequestration (Zeng et al., 2024). The body is capable of actively resorbing extruded disc material. Conservative treatment creates the conditions for this to happen.
What is the difference between a disc herniation and a slipped disc?
They describe the same thing — disc material that has escaped the intervertebral space. "Slipped disc" is an informal term that is technically inaccurate: discs don't slip. The anatomically correct terms are protrusion (bulge), herniation (prolapse), and sequestration — each describing a different degree of disc tissue displacement.
Is it safe to see a chiropractor with a disc herniation?
Yes, when it is clinically appropriate. A thorough initial examination identifies which patients are suitable for chiropractic care and which require medical co-management or surgical referral. Chiropractic adjustment does not cause disc herniations or worsen an existing one when applied correctly. Our motorised flexion-distraction table allows us to treat even larger herniations with a fully passive, controlled approach.
Who treats disc herniations?
Orthopaedic surgeons, neurologists, neurosurgeons, physiotherapists, and chiropractors all treat disc herniation. The appropriate first step depends on symptom severity and neurological picture. For most patients without acute neurological emergency, conservative management — with or without chiropractic care — is the recommended starting point.
Disc herniation or sciatica — what's the difference?
Sciatica describes a symptom (pain radiating down the leg along the sciatic nerve distribution) rather than a diagnosis. A lumbar disc herniation is one of the most common causes — but not the only one. Piriformis syndrome, sacroiliac joint dysfunction, and spinal stenosis can all produce sciatic-type symptoms. Accurate diagnosis distinguishes between these and guides the right treatment.
Can I continue to exercise with a disc herniation?
Yes — with the right guidance. Complete rest is counterproductive for most disc herniations. Walking, swimming, and specific stabilisation exercises are generally beneficial. High-impact activities, heavy lifting, and positions that provoke radiating pain should be avoided in the acute phase. We develop an individual programme based on your presentation, not a generic list.
Discover which therapist fits you best:
Also relevant: [Acute Back Pain →] | [Sciatica →] | [Hip Pain →]