When to Have Back Surgery for Herniated Disc

Yes, some of the time it is needed to go to the surgical procedure. But when to have back surgery for herniated disc (PLID)? – After applying physiotherapy and medication plan, if not get rid, can be applied to surgery.

In the lumbar region of the spinal vertebrae, the intervertebral disc herniates for any external or internal pressure.

We know intervertebral discs are composed of 2 types of matter, one internal nucleus pulposus, and one annulus fibrosus.

Here, annulus fibrosus is ruptured and nucleus pulposus proceeds outward. After that, it puts pressure on the ligament nerves and another surrounding structure. Then several complications stand there.

For example, there are several body organs that are affected. Sometimes it will be cured easily.

When to Have Back Surgery for Herniated Disc

Most of the time it is cured by physiotherapy treatment and some of the time surgery is needed. When pre-operative and post-operative physiotherapy treatment is very important to get cured rapidly.

Using this disorder, how can get benefit?

Are you interested to know how to benefit by facing a big problem? Yes, if we can technically deviate this problem to the way of improvement of whole life using skilled hands. Of course, I will gain success and I will gain benefit from this.

For example, if anyone felt the PLID problem on his or her lumbar spine they need to get treatment. Not only is there where he felt pain but also total surrounding areas organs will be checked and treated.

Thus, the benefit stands here: several exercises and musculoskeletal physiotherapy treatment make recovery and healing of surrounding muscles, tendons, ligaments and bone structures.

Easily diagnosed herniated disc without money

You know herniated disc diagnosis by MRI test is very costful for the lower-earning person. If they can be done at no cost. It will be very helpful and interesting for all.

Nowadays, physiotherapists can check the status of PLID within 5 minutes. Using a physical special test.

Testing procedure:


Test 1: Straight leg raising test

Simply patient lie in the supine position on a flat bed. The physiotherapist takes his or her leg in a straight position. Now lift it upward straightly.

Here using a goniometer for measurement of the angle of the hip joint is necessary. If the pain starts to radiate from the lumbar region at (35-70)degree SLR test is positive. Thus, I can apprehend the measurement without any cost.

Test -2: Slump test

Position: Sitting

Procedure: The chest is slouchy and hand kept on the back. Neck forward. Hip 90-degree flexion and knee extend fully.

Next to Ankle move in direction of dorsiflexion and plantar-flexion

Test -3: Reflexes

Check reflexes by using a reflex checker apply on the achilles tendon.

Test – 4: Sensory testing

Close the patient’s eye. Now, the physiotherapist will touch the leg bilaterally and ask to the patient – is he or she feeling the sensation of this touching? Here we can get results in positive or negative dermatomal conditions.

Anatomy relevant to disc

Between the pair of vertebrae, one by one disc is present. Disc increases enough height of the body. The main function of the disc is:

  • Absorbing shock when performing any jerky movement.
  • Prevent the spinal fracture
  • Increase the height of the human body
  • Maintain smoothness in the spinal movement
  • The disc provides flexibility in spinal movement

The posterior side of the disc is covered by the posterior longitudinal ligament. Posteriorly, bi-laterally passes the spinal peripheral nerve and the posterior side of posterior longitudinal ligament passes the spinal cord. Posterior longitudinal ligament always protects the herniation. Some blood vessels and nerves are supplied in each disc.

There are 4 types of the prolapsed lumbar intervertebral disc that are explained clinically. That is:

A. Bulging: First stage of disc prolapses

B. Protrusion: Second stage.

C. Extrusion: Third stage.

D. Sequestration: Severe stage.

How to ensure disc prolapse

  1. When finding the muscular weakness in dorsiflexion.
  2. Muscle weakness found in great toe extensions.
  3. Scoliosis found in the spine.
  4. Radiated pain feels in the thigh and leg.
  5. Pain increases or decreases when performing hyper-extension or forward flexion in spinal movement.
  6. Weakness is found in some of the movements of the lower limb.

Causes of a herniated disc

  • Various times we saw that people would carry any heavy weight with their hands and their posture was not good. When they listen to a sound on their spinal vertebrae. The sound was a disc herniation. The reason for that is high-stress effects on the disc.
  • Road traffic accident
  • Fall from height
  • Physical assault
  • Postural dysfunction
  • Sustain with bad posture for a long period of time
  • When posterior longitudinal ligament becomes weak. It cannot protect the disc from herniation.
  • When the back muscle becomes weak, it is a risk factor for PLID.
  • Muscle spasm is another cause of disc herniation.

Risk factor

  1. Men are more affected than females.
  2. Most affecting age 20 to 50 years old
  3. Overweight can make the environment for herniation
  4. Regularly driving cars for a long period of time.
  5. Weight lifting with abnormal posture.
  6. Hard-working job.
  7. Lack of activity in daily living
  8. Smoking habit.
  9. Lack of normal flexibility, strength, endurance, and capability.

Physiotherapy for disc-herniation

In herniated disc, physiotherapy is more effective than another treatment. The maximum time it is the problem of herniation can be solved without any surgery. So, without physiotherapy, we should not go for surgery.

If surgery is needed. Post-surgical physiotherapy is another important factor in confirming the absolute rehabilitation process. If post-surgical physiotherapy continues (4-6 weeks), it may ensure proper rehabilitation of disc herniation.

Physiotherapy treatment procedure

  • Stretching exercise
  • Stretch the adductor group of the muscle of hip joint in prone lying
  • IT band and latissimus dorsi stretching exercise in side-lying
  • Release of pectoralis major muscle
  • Manual traction
  • Core stability exercise
  • Strengthening exercise
  • Vertebral mobilization
  • Transverse mobilization

Electrotherapy treatment procedure

  1. Ultrasound therapy
  2. Microwave diathermy
  3. TENS therapy
  4. Others, cryotherapy.

Awareness is necessary with treatment

Do not lift heavy weights within 6 months when treatment is starting.

Radiological test

  • MRI
  • X-ray



  1. Naproxen
  2. Aceclofenac
  3. Indomethacin
  4. Diclofenac, says Dr. Amir Ali.


If not get recovery by physiotherapy and using medication. Then it needs to be going to the surgical procedure.

Last clinical words

I hope it will help you. You can read another treatment-related article.

Prescription for a patient

Patient name: Noman Abdullah

Age – 26

Symptoms of his:

1- Straight leg raise, problem found in both sides (left leg pain starts at 40 degrees and in right leg pain starts at 30 degrees)

2- When performing morning walks the pain is increasing

3- There is usually no pain at all

Now the treatment performed by the doctor is given below,


1 – Ball mobilization therapy procedure,

Use three pillows below the chest in prone lying, in the extension of the spine, now longitudinally mobilize the middle of the lower back. By stuck in the basketball, using elbow of the physiotherapist.

2- Transverse ball mobilization on the lower back.

3- Use the extension principle, because it is easy for this type of prolapsed lumbar intervertebral disk patient.

3- Manual spinal mobilization above the whole spine.

4- Treatment performed in flexion principle of McKenzie.

5- Since, iliopsoas flex the hip, so give the resistance to hip flexion for strengthening the hip flexor group of muscles.

6- Since, gluteus and hamstring extend the hip joint, so give the resistance in hip extension for strengthening of hip extensor group of muscle.

7- Erector spinae and core muscle strengthening:

Patient position – supine lying

The hand is straight upward and gives force posteriorly with resistance.

8- Follow the instruction regularly, without any change.

There will be correction that is possible rapidly.

Other treatments

1. Erb’s palsy

2. Physiotherapy for frozen shoulder

3. De quervain’s tenosynovitis physiotherapy treatment

4. Physiotherapy for ankle: Easy to cure

5. Cerebral Palsy: Causes, Types, and Physiotherapy Treatments

6. The role of physical therapists in wound management

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Last updated: 20/4/2020

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