One of my physio mentors told me to think of a disc like one of the ketchup packets you get at McDonald’s. This essentially captures how discs work: fluid-filled packets that sit between your spine segments (see the highlighted blue thing in the image), cushioning and spacing them out. A herniated disc, also known as a slipped disc or a ruptured disc, occurs when the soft inner core of a spinal disc pushes through a crack in the tougher outer layer, creating a bulge that can put pressure on a nerve. This can cause pain, numbness, or weakness in the area where the affected nerve travels.

Back pain/Sciatica FAQs

Why does my leg hurt if the problem is in my back?

I always tell my sciatica patients to picture a child stepping on a garden hose. Now imagine trying to water your garden—no luck, right? Now think of the painful part of your leg like the frustrated gardener. Whenever a structure such as a disc, joint or muscle pushes on a nerve, it can interfere with the flow of nerve signals and other fluids that keep the nerve healthy. This causes irritation and pain in the area the nerve travels to. Of all the nerves that travel from your back into your leg, the largest and most affected nerve is your sciatic nerve: hence the name sciatica.

The solution: get the child off the hose!

So it’s not necessarily a disc?

While herniated discs can create significant discomfort, the disc itself doesn’t always cause the pain and just because you have a herniated disc doesn’t mean you’ll feel pain. Some research suggests that many of us (over 50%) would likely show a disc herniation at some level and not feel any back pain at all.

Many other structures around your spine can give you back pain, such as the joints between your spinal segments and your lower back muscles. Some studies have linked back pain to other factors such as muscle strains, muscle imbalances and posture. The key to fixing the problem lies in a comprehensive assessment and diagnosis. In other words, you need to figure out whether it is indeed a child standing on your garden hose and where along the hose the child is standing. In every case, regardless of whether the pain is caused by a herniated disc, arthritis or other joint or muscle issue, patients almost always end up with a comprehensive strengthening and mobility program.

What if it is a disc?

So, you’ve had a thorough assessment and your physiotherapist decides they can’t rule out a disc issue–now what? I chose my words very carefully in that last sentence, as the only way to definitively diagnose you with a disc issue is to confirm with an MRI, getting an appointment for which–where I live and work–can take months, a frustrating wait. For this reason, I tell my patients that while I can’t definitively diagnose them with a herniated disc until the MRI, we can begin to treat them with the assumption that a disc herniation is present.

What does that mean? My initial approach focuses on reducing pain, improving mobility, and strengthening the surrounding muscles to support the spine through targeted exercises, manual therapy, and other treatment modalities. I also educate patients on proper body mechanics, ergonomics, and techniques to avoid flaring up their symptoms while we strengthen and condition around the spine.

In many cases, by the time the MRI appointment comes around, my patients tell me their back feels almost back to normal, even if their MRI still picks up a herniated disc–wild, right?

What other structures could be causing the pain?