Leg pain related to a Disc wall bulge / Slipped disc

Symptoms

• Shooting (lancinating) pain in to the leg ± pins & needles / numbness ± muscle weakness affecting the leg
• Low Back pain ± buttock pain
• Aggravated by flexion / extension of the back,
• ± coughing / lifting
• eased by lying down.
• No associated systemic disease such as cancer.
• No or limited slippage of one vertebra upon the next.
• No disturbance of sphincter function or loss of sensation in the perineum

First episode <6 weeks duration Muscle strain or facet joint strain

Muscle Balance Physiotherapy

Prolapsed disc irritating the local nerve Muscle Balance Physiotherapy, anti-inflammatory medicines, pain controlling medicines (Conservative Care)

First Episode >6 weeks duration

NOT responding to Muscle Balance Physiotherapy

Prolapsed Disc irritating the local Nerve ± High Intensity Zone or disc leaking pain producing products

MRI Scan advised

Further Conservative care + increased analgesia,

Nerve root blocks, Caudal epidural injections, Facet Joint Injections. (Chronic Pain Management)

Recurrent repeated episodes

Failed Chronic Pain Management

Prolapsed Disc irritating the local Nerve ± High Intensity Zone or disc leaking pain producing products

Endoscopic Lumbar Decompression & Foraminoplasty / Microdiscectomy.

Worsening signs of weakness or numbness ± lessening back pain Increasing size of prolapse with nerve root Endoscopic Lumbar Decompression & Foraminoplasty / Microdiscectomy