Lumbar Disc Herniation Treatment Toronto
A lumbar disc herniation can cause pain and muscle spasm in the lower back. Some disc herniations also cause sciatica that involves pain, numbness, tingling or weakness in the leg or foot. Symptoms can occur when herniated disc material irritates or compresses a nerve root in the lower spine.
At My Toronto Chiropractor Clinic, Dr. Leslie Horowitz has more than 34 years of experience examining and treating patients with lower back pain, sciatica and symptoms associated with lumbar disc herniation.
Many people with lumbar disc herniation can be treated conservatively without surgery. Your examination helps determine whether your symptoms are consistent with a disc herniation, whether a nerve root may be affected, and whether chiropractic care is appropriate for you.
Depending on your examination findings, Dr. Horowitz may recommend one or more chiropractic treatments, which may include spinal manipulation or mobilization, PulStar® computerized multiple impulse therapy, soft-tissue therapy, ergonomic advice and individualized rehabilitative exercises.
Chiropractic Treatment for Lumbar Disc Herniation
Although many people with lumbar disc herniation improve with time and conservative care, an examination is important when symptoms are severe, persistent or accompanied by numbness, tingling or weakness. New or worsening neurological symptoms require prompt assessment.
Treatments we offer for a lumbar disc herniation may include:
- Spinal manipulation
- Spinal mobilization using an Activator instrument
- PulStar® computerized multiple impulse therapy
- Soft-tissue therapy for associated muscle tension and spasm
- Therapeutic modalities such as ultrasound, interferential current or muscle stimulation when appropriate
- Postural and ergonomic advice
- Spine-sparing strategies for sitting, bending, lifting and other daily activities
- Core and spinal stabilization exercises
- Guidance for home care and rehabilitation exercises
- Mindfulness-based meditation exercises and Cognitive Behavioural Activation
Knowing which movements, exercises and positions may aggravate your condition can be just as important as knowing what to do during your recovery.
Spinal Manipulation and Mobilization
Spinal manipulation or mobilization may be used as part of your treatment when examination findings identify restricted movement in joints of the lumbar spine or pelvis.
The technique selected depends on your unique examination findings, your bone density, medications you may be taking and/or other factors.
Treatment is modified according to how you respond to care and your comfort with a given modality.
PulStar® computerized multiple impulse therapy provides spinal mobilization without placing your body in a twisted position or using higher forces that may be used with some forms of manual manipulation. PulStar® provides a lower-force treatment option for patients who prefer or need an alternative to manual manipulation.
Goals of Treatment
- Reducing pain and muscle spasm
- Reducing irritation of an affected nerve root
- Improving spinal and joint movement
- Improving strength, stability and function
- Helping you return to normal daily activities, work and exercise
- Providing strategies that may help reduce future aggravation of your symptoms
What Is a Lumbar Disc Herniation?
The discs between the vertebrae of your spine act as cushions and help guide the movement of your spine. You can visualize each intervertebral disc as a jelly-filled doughnut, with the nucleus pulposus representing the jelly and a tough outer layer called the annulus fibrosus surrounding it.
As you age, spinal discs gradually lose water content and undergo changes that alter their shock-absorption abilities and make them less flexible. These changes are degenerative in nature and can make the outer portion of a disc more susceptible to damage.
Disc degeneration is caused by things like injuries, aging, repetitive physical labor, or sitting or standing for extended periods. Age is the most common cause of bulging and herniated discs.
A disc herniation occurs when material from the nucleus pulposus pushes through a tear or weakened area in the outer annulus. A lumbar disc herniation may cause lower back pain and can irritate or compress a nearby spinal nerve root, resulting in pain, numbness and tingling that travels into the buttock, leg or foot. When severe, a disc herniation can cause significanat leg weakness and muscle atrophy.
When a lumbar disc herniation irritates or compresses a nerve root that contributes to the sciatic nerve, it can cause sciatica.
Disc Bulge, Extrusion and Sequestration
Disc herniations are described in different terms, depending on the extent of disc disruption and the degree to which the inner nucleus material is disrupting the outer disc area.
Disc bulge — The nucleus pulposus pushes into the surrounding annulus fibrosus, beyond its normal boundary. The outer annular fibres remain intact, so the nucleus pulposus has not broken through the outer annulus.
Disc extrusion — Nuclear disc material breaks through the outer annulus, and leaks out into the spinal canal where nerves are located.
Disc sequestration — A fragment of extruded disc material extends out from the annulus and becomes completely separated and may migrate within the spinal canal.
A person who shows disc degeneration or who has a herniated disc does not always have symptoms.
Approximately 95% of symptomatic lumbar disc herniations in people aged 25–55 occur at L4-L5 or L5-S1.³
Lumbar Disc Herniation Examination
A thorough examination is important because leg pain, numbness, tingling and weakness can originate from various spinal conditions and a clear diagnosis is important for appropriate and timely treatment.
Your examination will include an assessment of your posture, overall spinal ranges of motion and segmental spinal movements as well as areas of pain or tenderness. Dr. Horowitz uses neurological and orthopedic testing to assess nerve function, muscle strength, sensation and reflexes in the legs.
Based on your history and examination findings, Dr. Horowitz will form a diagnosis and determine whether chiropractic treatment is appropriate. If additional diagnostic information is needed, Dr. Horowitz will send you for X-rays or may refer you for further diagnostic imaging.
Lumbar Disc Herniation Symptoms
Symptoms of a lumbar disc herniation can begin suddenly or develop gradually. They may include:
- Lower back pain — Intense, sharp, deep ache that may make sitting very difficult to do. Standing or lying on your back usually afford some relief.
- Sciatic Nerve Pain — Sharp, electric-like radiating or burning pain and/or numbness and tingling that extends into the buttock, thigh, leg, foot or toes on one side.
- Back Spasm — Intense muscle spasm or stiffness that makes bending forward or arising from a seat diffiult.
- Muscle weakness — Nerve-root involvement may cause weakness in muscles of the leg, ankle, foot or toes. New or worsening leg or foot weakness requires prompt assessment.
- Symptoms with coughing or sneezing — Coughing, sneezing or straining may increase symptoms due to an increase pressure within the spinal canal.
Will Herniated Disc Pain Go Away?
The good news is that the outlook for most people with a symptomatic lumbar disc herniation improve with time and conservative care, without requiring surgery. Research indicates that approximately 60–80% of patients experience resolution of symptoms within 6–12 weeks, with approximately 80–90% experiencing symptom resolution over the longer term.²
MRI findings do not always correspond with pain. Disc degeneration, bulges and protrusions are commonly found on MRI in people who have no back pain. Research has also shown that these findings become increasingly common with age.¹ For example, a systematic review estimated that disc bulges are present in approximately 30% of 20-year-olds who have no pain and 69% of 60-year-olds who have no pain.
For this reason, an MRI finding should not be considered in isolation. Conversely, some people can experience significant pain even when their MRI findings appear relatively minor.
Risk Factors for Lumbar Disc Herniation
Several factors may be associated or increase your likelihood of developing a lumbar disc herniation.
- Age — Lumbar disc herniation is most common between the ages of 30 and 50 years of age.⁴
- Sex — Symptomatic lumbar disc herniation is more common in men than women.⁴
- Genetic and family factors — Inherited factors can influence your susceptibility to disc degeneration and lumbar disc herniation.⁴
- Heavy physical work — Repeated heavy lifting and other physically demanding activities can increase loading on the lumbar spine and are associated with an increased risk of lumbar disc herniation.³
- Repeated bending and twisting — Occupational exposure involving repeated forward bending, twisting or working with the spine in non-neutral positions.³
- Prolonged sitting — Prolonged sitting, particularly when combined with other occupational or physical factors.³
- Whole-body vibration — Repeated exposure to whole-body vibration, such as prolonged driving or operating heavy machinery.³
- Smoking — Nicotine and other components of tobacco smoke can reduce blood flow and nutrient transport to the intervertebral discs and can adversely affect disc-cell function.⁵ ⁶
- Higher body weight — Higher BMI has been associated with an increased risk of lumbar disc herniation with radiculopathy.³
When to Seek Immediate Medical Attention
Most lumbar disc herniations do not require emergency treatment. However, significant compression of the spinal nerves can occasionally cause serious neurological problems. Seek immediate medical attention if you develop:
- Loss of bowel or bladder control
- Numbness or loss of sensation around the buttocks, genitals or inner thighs
- Severe or rapidly worsening weakness in one or both legs
- New or rapidly worsening difficulty controlling the foot or leg
These symptoms can indicate significant nerve compression, including cauda equina syndrome, a rare but serious medical emergency involving compression of the nerves at the lower end of the spinal canal.
New foot drop requires prompt medical assessment. If weakness or loss of control of the foot or leg is rapidly worsening, seek immediate medical attention.
Book a Disc Herniation Examination in Toronto
If lower back pain, sciatica, numbness, tingling or leg weakness is interfering with walking, sitting, working, sleeping, exercising or your everyday activities, a chiropractic examination can help determine the likely cause of your symptoms and whether chiropractic treatment may be appropriate for you.
Have questions before booking? Visit our Frequently Asked Questions or Fees & Appointments pages for more information about your first visit, treatment and clinic fees.
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References
1. Brinjikji W, Luetmer PH, Comstock B, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR American Journal of Neuroradiology. 2015;36(4):811–816. Read the full study — PubMed Central
2. Kögl N, Petr O, Löscher W, et al. Lumbar disc herniation: the significance of symptom duration for the indication for surgery. Deutsches Ärzteblatt International. 2024;121:440–448. Read the full study — PubMed Central
3. Hincapié CA, Kroismayr D, Hofstetter L, et al. Incidence of and risk factors for lumbar disc herniation with radiculopathy in adults: a systematic review. European Spine Journal. 2025;34(1):263–294. Read the full study — PubMed Central
4. Pojskic M, Bisson E, Oertel J, et al. Lumbar disc herniation: Epidemiology, clinical and radiologic diagnosis WFNS spine committee recommendations. World Neurosurgery: X. 2024;22:100279. Read the full study — PubMed Central
5. Huang W, Qian Y, Zheng K, Yu L, Yu X. Is smoking a risk factor for lumbar disc herniation? European Spine Journal. 2016;25(1):168–176. Read the full study — PubMed Central
6. Elmasry S, Asfour S, de Rivero Vaccari JP, Travascio F. Effects of Tobacco Smoking on the Degeneration of the Intervertebral Disc: A Finite Element Study. PLoS ONE. 2015;10(8):e0136137. Read the full study — PubMed Central