Back pain related to a Disc wall bulge / Slipped disc

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

Presentation	Diagnosis	Options
First episode <6 weeks duration	Muscle strain or facet joint strain	Muscle Balance Physiotherapy
First episode <6 weeks duration	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 and nerve root compression ± disc wall disruption & extrusion.	Endoscopic Lumbar Decompression & Foraminoplasty / Microdiscectomy.