Lumbar disc herniation is not diagnosed based on MRI alone.

'Lumbar disc herniation' is a commonly used expression in daily life. More precisely, this term is used when referring to a condition in which the intervertebral disc between lumbar vertebrae protrudes or herniates and these changes are associated with lower back pain or leg nerve symptoms.

However, a disc finding on MRI does not always cause pain. Disc herniation or degenerative changes may also be found in individuals without pain.

For this reason, a lumbar disc problem is not assessed from imaging alone. We must examine together where the current pain radiates, whether there are changes in muscle strength and sensation, and whether the areas visible on imaging match the actual symptoms.

The intervertebral disc is a structure that distributes impact between vertebrae and helps the lumbar spine move.

With aging or the accumulation of repetitive stress, the water content and elasticity of the intervertebral discs may decrease, and their shape may change. Such changes may be part of the natural aging process.

The fact that a disc is bulging or herniated does not necessarily mean surgery is required. The actual treatment direction is determined by jointly assessing pain, nerve function, and limitations in daily activities.

Lower back pain

The lower back may hurt in the center or on one side, and you may experience discomfort when sitting or bending forward. However, a disc cannot be definitively confirmed based solely on lower back pain.

Pain radiating from the buttocks down to the leg

If the lumbar nerve is irritated, you may experience a sharp or pulling pain radiating from the buttocks down to the thigh, calf, and foot.

Numbness in the legs and feet

You may experience numbness, a burning sensation, or an electric shock-like feeling in a specific area.

Muscle weakness

You may experience changes in leg strength, such as difficulty lifting the ankle or toes, or weakness in the knee.

Pain that worsens with coughing or sneezing

There are cases where leg pain worsens when intra-abdominal pressure increases. However, we do not definitively diagnose a disc herniation based solely on these symptoms.

In many cases, the current direction of symptoms can be initially determined through history taking and physical/neurological examinations to assess whether they are related to lumbar nerve issues.

Pathway of pain and numbness

We check whether the pain starts in the lower back and which parts of the buttock and leg it travels to.

Lumbar movement

We examine how symptoms in the lower back and legs differ between bending forward, straightening up, and sitting.

Muscle strength examination

Compare the strength of extending the knee, lifting the ankle and toes, and standing on the toes to the left and right.

Sensory and reflex examination

We check sensation in the thigh, calf, and foot, as well as knee and ankle reflexes.

Gait examination

We check whether you drag your foot or have difficulty walking on your heels or toes.

Based on these examination results and the MRI performed when necessary, we determine the treatment direction.

In the following cases, an MRI may be helpful in determining treatment.

• If leg muscle strength gradually weakens
• If it is difficult to lift the ankle or toes
• In cases where there are changes in bowel and bladder control or decreased sensation in the perineal area.
• If leg pain and numbness persist or worsen despite appropriate treatment
• When it is necessary to decide whether an injection or surgery is needed
• If infection or other conditions are suspected

In early back pain without warning signs, an MRI is not always performed first.

The size of the disc seen on imaging does not always correlate with the intensity of pain.

The important points are as follows.

• Whether the location of the imaging matches the actual site of pain
• Is leg muscle strength and sensation stable?
• How much is your walking and daily activities limited?
• Whether symptoms are improving or worsening

Even if the MRI report sounds frightening, you must also examine your current function and nerve status.

Activity modification

Reduce movements that cause severe pain, but if there are no warning signs, maintain daily activities within your possible range rather than lying down for a long time.

Chuna manual therapy

It may be considered as part of a treatment plan when there are no progressing neurological abnormalities and movement and muscle function in the lower back and pelvis need to be managed together.

Chuna manual therapy is not a treatment that pushes a herniated disc back in by hand. We proceed in a direction that confirms the movements currently causing pain, manages the joint and muscle function of the lumbar spine and pelvis, and aids in restoring daily activities.

Before and after treatment, it is essential to confirm whether leg pain, numbness, muscle strength, and gait are stable.

Acupuncture treatment and pharmacopuncture treatment

It may be selected according to the patient’s condition after checking pain and muscle tension in the lower back, buttocks and legs.

Exercise and Rehabilitation

While confirming nerve function, we gradually restore movement of the lumbar spine and hip joint, as well as trunk and lower limb muscle strength.

Analgesics and neuropathic pain medications

Medications may help reduce pain and numbness and assist with sleep and daily activities.

However, even if pain decreases, muscle weakness or sensory changes may progress; therefore, one should not judge that the condition has improved based solely on symptom reduction. If long-term or repeated use is required, the individual's gastrointestinal, renal, and cardiovascular status, as well as other concurrently taken medications, must be reviewed.

Steroid injection and nerve block

If muscle strength and sensation are stable, much lumbar disc disorder can be treated with the Chuna manual therapy, acupuncture, pharmacopuncture, and exercise described above. In the acute stage when nerve pain is severe, steroid injections or nerve blocks are sometimes used alongside them, with effects usually closer to short-term pain control lasting a few weeks to a few months.

Because risks such as elevated blood sugar and reduced bone health accumulate the more they are repeated, if repetition is needed, diabetes and infection risk, along with the number of previous injections, must be evaluated alongside actual muscle strength, sensation, and function.

Surgical evaluation

Surgical evaluation is necessary in cases such as the following. In such situations, surgery can be an essential choice to protect the nerves.

• When leg muscle strength drops rapidly
• When there are changes in bowel or bladder control and perineal sensation
• When severe leg pain and functional decline persist
• When daily life is significantly restricted despite appropriate non-surgical treatment

If there are no such warning signs, there is no need to make a rushed decision. While surgery can reduce pain more quickly, there is research showing that after about 1 year, outcomes were similar to non-surgical treatment.

Even after surgery, once the surgical site stabilizes, Korean medicine treatments such as Chuna manual therapy can help the process of regaining function in surrounding joints and muscles. The starting time and intensity are determined in consultation with the surgical medical team.

Some disc herniations and nerve symptoms may improve with non-surgical treatment and over time.

However, not all patients show the same course. Even if pain decreases, deterioration in leg strength, sensation, and gait cannot be considered simple improvement.