A man's bare back from behind, his hand on his lower back where a red glow marks the lumbar spine, the area a herniated disc often affects

Herniated Disc Treatment in Kuala Lumpur: Signs, Causes and Care

Herniated disc treatment in Kuala Lumpur starts with an examination and, where a disc problem is suspected, an MRI. A slipped disc in the neck can send pain, numbness or weakness into the shoulder, arm and fingers. Low in the back, it can travel into the buttock, leg and foot.

In my experience, a disc herniates only after it has been damaged. Years of sitting, bending, twisting and lifting under load wear its outer fibers until they tear. Even so, an MRI report naming a herniation cannot, by itself, locate the source of pain. My Back Pain to Leg Pain talk makes the point that disc damage most often causes no symptoms at all.

Care is planned from the examination and MRI together. It combines chiropractic manipulation that is non-rotatory using the Activator instrument, flexion-distraction, physiotherapy, soft tissue work and exercise matched to the stage. Forceful, high-speed twisting is avoided, and care is kept within what you can comfortably tolerate. Surgery, as I say in my Sciatica vs Slipped Disc video, is the last option. The sections below cover the stages, urgent signs, causes, focused care, progress and daily habits.

For more information about herniated disc treatment, contact the Bukit Damansara (KL) main center: WhatsApp+60 17 269 1873 Call+603 2093 1000

Herniated Disc Treatment: Key Takeaways

QuestionShort answer
Is a herniated disc a slipped disc?A herniated disc is one stage of what people call a slipped disc. My short video The Truth About Herniated Discs defines a herniation as a rupture: the last intact outer fibers tear and the center escapes.
Can an X-ray show a slipped disc?An X-ray cannot show the disc itself. It shows bone, while an MRI shows the disc and the space the nerves occupy. My verdict in Is Chiropractic Safe? 13 Questions Answered: an MRI is a gold standard.
Does a herniated disc need surgery?Surgery comes early for a herniated disc only in severe cases, such as a sequestered disc or infection. Otherwise, in my view, it waits until focused conservative care, properly given, has not worked.
Which signs are urgent?New numbness around the genitals or anus, new difficulty passing urine, or loss of bladder or bowel control needs urgent medical attention at a hospital emergency department straight away, within hours.
Can a herniated disc heal on its own?In my view, a herniated disc does not return to normal. As my Back Pain to Leg Pain talk explains, the body tries to repair a damaged disc, but daily habits damage it faster.
What is avoided with a herniated disc?Forceful, high-speed twisting, towel or strap pulls on the neck, bending and twisting at the waist, deadlifts and yoga. Lifting is avoided where possible and kept under 2 kg. Hot packs stay off a damaged disc as well.
How common are disc problems?Bulges and herniations account for 40 percent of chronic neck and back pain, by the statistics I give in Bulging Disc vs Herniated Disc. Joint problems account for 45 percent, muscular or other forms of disc problems for 15.
Herniated Disc Guide: Sections at a Glance

Herniated Disc Stages: From Bulge to Free Fragment

A disc changes in stages, and a herniation sits in the middle of them. Each disc has a gel-like center, the nucleus pulposus, held in place by rings of outer fibers, the annulus fibrosus. My Back Pain to Leg Pain talk puts it frankly: “I loosely use the word slip disc, but in reality, discs don't slip.” Each stage is a progression of the one before it. My short stage videos define them in this order:

  1. Damaged or degenerated disc: the starting point. Its outer fibers weaken, and the center loses water.
  2. Bulge: the fibers have swollen more than usual. In its true meaning, a bulge presses on no nerve and is still contained (Bulging Discs: Explained in 20 Seconds).
  3. Protrusion: the center pushes outward, toward the spinal canal or a nerve exit, but the outer fibers hold (Protruded Disc: What You Need to Know).
  4. Prolapse: barely contained. A last few outer fibers stop the center from rupturing into the canal (Prolapsed Disc: A Simple Explanation).
  5. Herniation, also called a rupture: the subject of this guide. The last outer fibers tear, and the escaping center reaches the spinal cord, its covering sac or a nerve root (The Truth About Herniated Discs).
  6. Extrusion: the center is forced from the middle of the disc out to its rim (Why Extruded Discs Aren't As Bad As You Think). In that short video, I say these large herniations need immediate attention. To me, that means a prompt assessment, not automatic surgery, and it can mean focused conservative care.
  7. Fragmentation, in two kinds: in a partial fragmentation, a piece of the center has broken away but still clings to the disc. When that piece tears loose and floats free in the spinal canal, the disc is fully fragmented, also called a sequestered disc. My short video The Shocking Truth About Fragmented Discs calls this free-floating kind “the last and most dangerous type of a slipped disc”.
Spinal discs viewed from above in order of damage, from a normal disc through degeneration, prolapse and extrusion to a sequestered disc
Stages of disc damage seen from above. The herniation stage falls between the prolapse and the extrusion.

Slip disc covers all of these stages in everyday speech. At every stage, care is planned from the MRI and examination, kept non-rotatory and matched to the stage. The guide to what causes a herniated disc looks at how a herniation comes about. Another sets out the slip disc treatment options in Kuala Lumpur.

In the video above, Bulging Disc vs Herniated Disc, I use a disc model to show a damaged disc bulging first and then herniating. A tear at the back of a disc matters more than one at the front, because the spinal cord and nerves lie directly behind it.

Is a Slipped Disc Serious?

A slipped disc that has moved beyond its normal borders is serious to some degree. My scale for seriousness runs from 0 to 10, and 10 means life-altering and critical. A disc that pushes aside the thecal sac, the sac around the spinal cord and nerves, or presses on a nerve scores 3 to 5. A true bulge, swollen only slightly beyond its borders, scores 1 or 2. The tissues the disc affects decide how serious one case is.

Slipped Disc Assessment at Two KL Centers

Both KL centers assess herniated and slipped discs. When someone arrives with an MRI, its images are almost always the first thing I look at, before the examination. Without a scan, the history and examination come first, and imaging follows only when they suggest a joint or disc problem. The history covers where the pain began, how it travels and what makes it better or worse. The examination checks posture, movement, reflexes, sensation and strength.

In my view, muscle spasm alone is seldom intense enough to explain moderate or severe back pain. Muscles do tighten to guard a painful level, so I look for the joint or disc behind the guarding.

Please bring the scans themselves, on CD or film, and not just the written report, along with notes on what you have tried. The CSC locations page lists both addresses and opening hours.

Each center's contact page shows directions and parking, for Bukit Damansara and for Bandar Sri Damansara. Bringing a family member to the first visit is welcome, since two people remember more than one.

Herniated Disc Symptoms and Urgent Signs

What a herniated disc does depends on its level and on the nerve it reaches. Common symptoms include:

  • Pain in the neck or lower back, often with stiffness after sitting.
  • From the neck: pain toward the shoulder blade, shoulder, arm or hand.
  • From the neck: neck and upper back pain that sharpens when the head tilts back, a common sign in my Back Pain to Leg Pain talk.
  • From the lower back: pain into the buttock, thigh, calf or foot. When the sciatic nerve is inflamed, this is sciatica.
  • Numbness, tingling or pins and needles along the same route.
  • Weakness, such as a weaker grip, a foot that catches or legs that tire on walking. Balance can suffer as well.
  • Pain that sharpens with a cough, a sneeze or a laugh, on turning over in bed, or during long sitting or bending.

Pain that travels below the elbow or the knee, with numbness or weakness, points to a nerve root. That changes the plan, the timeline and what is checked at each visit, far more than the size of anything on a scan. I have seen a large herniation bring only a mild ache, and a small one bring severe pain. Where symptoms are felt does not always show where the disc has torn.

Torn disc fibers are sensitive. My Back Pain to Leg Pain talk mentions people woken at night when they turn over. A cough, as I put it there, “feels like a knife gone through your back”, and even laughing can hurt.

In Bulging Disc vs Herniated Disc, I describe a cramp-like feeling in the lower back or buttock, sometimes running down the leg. From the neck, it can run down the arm. Yet many people I see have no back pain at all, only legs that feel weak. My Back Pain to Leg Pain talk explains why the back can stay pain-free. A tear can damage the disc's pain-sensing fibers, so they stop signaling and no warning comes.

Pain alone is a poor measure of the damage. In the same talk I say, “Pain is not a yardstick. Pain is a symptom.” When a nerve stays pressed for a long time, strength, sensation and walking distance can change, so a weakening arm or leg is checked promptly.

Less often, a large lower back disc sends pain into the scrotum or the perineum, the area between the genitals and anus. New numbness in that area, or new difficulty passing urine, needs the urgent assessment described next.

If you have back or leg pain associated with a herniated lumbar disc, get urgent medical attention, a thorough assessment at a hospital emergency department straight away, within hours, if numbness develops or worsens around your genitals, between your genitals and anus, or around your anus. New difficulty passing urine needs the same urgent assessment; loss of bladder or bowel control does not have to occur first, and if it does occur, it is urgent too. These symptoms have several possible causes. Some may call for an invasive procedure, but the assessment determines what care is appropriate, rather than assuming surgery is necessary.

Leg weakness that keeps getting worse should not be ignored. It calls for a careful assessment by a competent provider, and conservative care can continue only while the weakness itself is improving.

The upper extremity guide covers symptoms in the arms and hands. The lower extremity guide covers the hips, legs and feet.

What Causes a Slipped Disc?

What wears a disc down, in my experience, is everyday load. Sitting, above all slouched, raises the pressure inside it, and so do bending, twisting and lifting, worst when combined. As the outer fibers weaken, the center keeps pushing toward the weakest point. Common contributing factors include:

  • Long hours at a desk or behind the wheel with the back rounded.
  • Repeated bending and twisting at the waist, worst with a load in the hands.
  • Heavy lifting, or lifting while bent or turned.
  • Falls, sports injuries and road accidents, which can start the pain, though in my view the disc was already damaged.
  • Disc dehydration, where age is one factor among several, beside genetics, daily habits, posture and earlier injury.

The guide What Are the Causes of a Herniated Disc? takes each cause further. It also covers the laboratory tests that loaded healthy discs, and a small study of breaks from sitting.

Disc Problems in Children and Teenagers

Herniated discs are not common in children or teenagers, but they do occur, even before the teenage years. My youngest herniated disc patient was a seven-year-old girl, with herniations at more than one level. I call her herniation “moderate, bordering severe” in my Back Pain to Leg Pain talk. Aggressive gymnastics training had forced her into positions meant to improve her mobility and flexibility, and in my view it damaged her discs.

Children can take part in sport, and some train with hopes of a professional career. Parents need to make sure the trainer and the training do not put the spine at risk. That care matters most where a parent has a congenital spinal condition that may have been passed on.

Each vertebra has a bony ring at its rim where the disc attaches. In the mid-back and lower back, that ring finishes fusing at about 13 to 19 years of age (Costa and colleagues, 2021). Very young children receive non-force care. For a teenager, a low-force method may be used, such as chiropractic manipulation that is non-rotatory using the Activator instrument. The guide to chiropractic care for children explains slipped discs in teenagers.

My Back Pain to Leg Pain talk notes of the late teens and early twenties, “I have a lot of those patients.” The same caution holds for them, and for people in their thirties who train in the gym as if for international competition. Forcing strength, mobility, flexibility and muscle mass in a short time can bring on degenerative changes and spinal problems, some lasting years or for life. Training and exercise are good, with moderation in every activity, especially for the young.

MRI or X-Ray: What Each Scan Shows

An MRI shows the disc itself, while an X-ray costs less but shows only bone. For the lower back, the examination decides which scan, and I rarely need both. An X-ray may be enough when alignment or a facet joint, one of the small joints at the back of each level, is in question. When a disc problem is suspected, I send for an MRI, since a final diagnosis should never be a guess.

I talk about the MRI in Is Chiropractic Safe? 13 Questions Answered. There, I describe it as “a gold standard in diagnostic imaging of neck and back or joint issues”. It uses no radiation and shows bone, joint, muscle and ligament, and even how much space the nerves have.

In the same video, I note that a disc lies 6 to 10 centimeters beneath the skin, which is why imaging matters. A report also gives the direction of a herniation. Central means toward the middle of the canal, and paracentral just off center. Foraminal means into the opening where a nerve leaves the spine, and far lateral means beyond that opening. Each direction can press on a different nerve.

An MRI has limits as well. My Back Pain to Leg Pain talk covers why. Once a disc degenerates, the border between its center and outer ring can rarely be seen. A report may then name a bulge or a herniation from the disc's outline alone. In the same talk, I say that of all the MRIs I have read, I doubt five showed the center itself coming down. That is why I read the MRI against the examination, never on its own. The MRI scan guide explains how the scan is done and how to prepare.

Ligaments, Facet Joints and Other Conditions Beside the Disc

Side-view MRI of the spine, with a red circle around a level where the spinal canal narrows
MRI, side view. The red circle marks a level where the spinal canal narrows.

Other changes can sit beside a herniated disc. In my view, they are common and at times occur together at the same level. A disc bulge, herniation or extrusion can sit beside a thickened ligamentum flavum and enlarged facet joints.

The ligamentum flavum is an elastic ligament inside the spinal canal, at the back. As a damaged disc loses height, the ligament can buckle inward, and the facet joints carry more of the load. In my view, the ligament thickens under load: long sitting, repeated bending and a disc that has lost height all strain it. Together, these changes can narrow the space for the nerves.

That narrowing can bring leg pain, numbness or tingling, a shorter walking distance, and stiffness on standing or bending. An MRI shows whether these structures are involved as well as the disc, and care is then planned for all of them.

Beyond the ligament and facet joints, most people I see with a slipped disc have other co-conditions as well. The most common are:

Herniated Disc Treatment Without Surgery

Herniated disc treatment without surgery, in my care, is focused conservative care. When I say conservative care, I always mean focused care. It is built on the MRI and examination findings and aimed at the causes they document. It covers the whole region around the damaged disc, not one spot, and it must do no harm. Routine back treatment is not focused care, and in my view many conservative therapies are useless. Apart from severe cases and urgent signs, surgery becomes an option only when focused care has been given properly and has not worked.

At CSC, the chiropractors and physiotherapists build this plan as one team, following NSD Therapy® methods and protocols, and it involves no injection or incision. I first created NSD Therapy® in 2006, for disc problems of the neck and back. Depending on the findings, a herniated disc therapy plan can include:

  • Chiropractic manipulation that is non-rotatory using the Activator instrument, or other low-force methods. These include SOT blocking, with padded wedges placed under the pelvis, and the Thompson drop technique, on a table section that drops a short way.
  • Flexion-distraction, where the spine is gently flexed and drawn apart on a moving table.
  • Spinal decompression in selected cases: a slow, controlled lengthening of the spine on a decompression table.
  • Therapeutic ultrasound or high-intensity laser therapy on the soft tissues around the affected level, always alongside exercise and manual care. Laser should feel mildly warm, not hot.
  • Electrotherapy (interferential current) where muscle guarding limits movement.
  • Trigger point and myofascial work on the paravertebral muscles, the muscles running beside the spine, and on the tissue covering them.
  • Cold therapy for the spine, with the QMD, a device that can cool or heat, set to cold only. Its heat setting is not used on a spine with a disc or facet joint problem.
  • Rehabilitation in the physiotherapy gym at the Bukit Damansara main center, once the spine is ready for it.

Discomfort during care means it is being done too aggressively, so tell the clinician at once. My motto, from Is Chiropractic Safe? 13 Questions Answered, is “No pain, more gain.” Possible effects and risks are explained before care begins.

With a herniated disc, forceful, high-speed twisting is avoided. In Sciatica vs Slipped Disc, I say cracking and twisting “should not be done on the spine that has a damaged disc”. Rotary manipulation is something I keep for spines where I am 100 percent sure no disc is damaged.

The Gonstead and Diversified techniques, as I put it in Is Chiropractic Safe? 13 Questions Answered, are great for mobilizing joints. Both use twisting moves, so neither is used on a damaged disc. In the same video, I call both wonderful methods for young people without degenerative joint changes or disc damage. The guide Gonstead, Diversified and Activator Techniques Explained compares them.

In Neck Cracks Are Dangerous, I explain how a towel or strap pull on the neck can turn a mild bulge into a severe herniation. The Ring Dinger guide looks at those pulls in detail.

The physiotherapy guide describes the physiotherapy methods, and the chiropractic adjustment guide the chiropractic side.

My understanding of herniated disc care comes from 30+ years in chiropractic and physiotherapy and from personal experience. I first dealt with a herniated disc more than three decades ago, and that experience led to years of focused study.

An Early Study of Spinal Decompression

The decompression methods in NSD Therapy® draw on an early, small study led by the neurosurgeon Norman Shealy (Shealy and Borgmeyer, 1997). The study did not test NSD Therapy® itself. It assigned 39 people with lower back pain at random to a decompression table or to standard traction. Both groups had daily 30-minute sessions, with similar ice packs, electrical stimulation and exercise.

Of the 23 with a ruptured disc on MRI, 14 had decompression and 9 had traction. Twelve of the 14 rated their improvement good or excellent, against 5 of the 9 on traction, none of them excellent. The authors called these findings preliminary and wrote that the procedures had not been subjected to review or scientific controls.

Later studies have found no clear difference between decompression and other forms of traction. The guide Spinal Decompression Therapy in Malaysia sets out one such trial. Where decompression is used here, it is one part of a plan, never the whole of it.

Progress Reviews, Timeline and Exercise

Progress is measured against the first visit. The same tests are repeated, pain is scored on a scale, and your own account counts. Is Chiropractic Safe? 13 Questions Answered gives my two checkpoints. With no improvement by the fifth session, you should be reassessed. If nothing has changed by the tenth, the two of you decide whether to continue.

Timelines vary with the size and stage of the herniation, the nerve involved and how worn the disc is. They also depend on how far habits such as sitting, sleep and walking change. With care at CSC under NSD Therapy® methods and protocols, I look for improvement within the first five sessions, my first checkpoint. Every plan is specific to the person, so I cannot give one length of care for everyone.

What ends an active plan is a plateau, not a date. I call that point maximum medical improvement (MMI): further weeks of care no longer change the findings on retesting. Care then moves to as-needed visits, with home exercises and preventive care.

Exercise generally waits until the spine is stable. For most people with a slipped disc, that comes between the fifth and seventh session, and for a few as early as the third. A herniation is a larger slip disc, so it usually takes longer: I prescribe exercise after two to about six weeks of care, three to five weeks on average. With an acutely inflamed herniated disc and acute pain, I start an exercise program no sooner than three weeks.

Kegel exercises are the exception. They strengthen the pelvic floor, and in my view they do not put the disc or its stability at risk, so they need not wait. In Neck and Back Self-Help Tips, I tell my patients to begin them straight away. I hold them to be a necessity for everyone with a lower back problem, herniations included. Contracting and relaxing the buttock muscles adds to them, as do side-lying leg raises that move the leg out, in and forward.

Once the spine is stable, the first program is gentle: some movement and basic strengthening that does not aggravate the disc. It can include core canister breathing, leg lifts, cat and camel and wall-assisted squats. Strength work for the glutes, hamstrings, calves and thighs follows as the severity allows. In Sciatica vs Slipped Disc, I explain that exercise and stretching have to suit both the condition and the person's age.

Every three to six months, I review and amend the exercises so they keep progressing. With a lower back herniation, they work the paravertebral muscles, the pelvic floor and the core stabilizers. With a neck herniation, they work the superficial and deep neck muscles, the upper back, the chest and the shoulders.

Nothing is a standard procedure, and each program is built case by case. A herniated disc is seldom an island, since it almost always comes with other conditions and disorders. All of them are weighed together before any exercise program is set, at any stage.

Exercise at CSC is supervised by chiropractors and physiotherapists. A review of 37 trials looked at exercise for long-standing low back pain without a specific cause. People often stopped doing their exercises, so its authors recommended supervision (van Middelkoop and colleagues, 2010).

Cervical Disc Herniation Treatment in KL

Cervical disc herniation treatment in KL is planned from the MRI and the examination, as for any disc. With arm pain, numbness or tingling from the neck, I advise never letting anyone crack or twist it with rotatory moves or exercises. Care stays non-rotatory and covers the whole neck, because its levels work as one chain.

In the neck, herniated discs are found most often at C4-C5, C5-C6 and C6-C7. Of the three, C5-C6 moves the most, and it is the one I see herniated most often.

In my view, C4-C5 and C5-C6 are the workhorses of the neck, and a head held forward over a phone loads them heavily. C6-C7 moves less and is harder to damage, yet it is a common site of injury under heavy load. It is seldom damaged on its own.

The level points to the nerve involved. A C4-C5 disc tends to affect the C5 nerve root: the neck, the top of the shoulder and the upper arm. A C5-C6 disc affects the C6 root: the shoulder, upper arm, forearm and thumb side of the hand. A C6-C7 disc usually affects the C7 root. In my experience, that brings symptoms in the back of the arm, the forearm and the middle finger, sometimes the index or ring finger. It can also weaken straightening of the elbow or fingers, and bending of the wrist.

A neck disc can also press on the spinal cord itself. My Back Pain to Leg Pain talk describes how that can reach the arms, the hands and even the legs. It can bring weakness, trouble walking or standing, digestive disturbances, heart palpitations and breathing problems. Any of these needs prompt medical assessment.

The top two joints of the neck, between the skull and C1 and between C1 and C2, have no disc. They rely on joints and ligaments instead, so a disc herniation cannot occur there. The guides to the occiput and atlas (C0-C1) and atlas and axis (C1-C2) cover those joints.

Each neck level with a disc has its own guide: C2-C3, C3-C4, C4-C5, C5-C6, C6-C7 and C7-T1. The neck pain guide covers the neck as a whole.

Neck Muscles or a Damaged Disc?

Neck pain does not always start at the disc. In my Neck Trigger Points and Exercises video, I explain that neck problems often begin in the muscles, such as the trapezius and rhomboids. Left long enough, they reach the joints and, in time, the discs. It works the other way too: a joint, nerve or disc problem can feel like a tight muscle. So the exercises in that video wait until a provider has checked the cause.

The chapters and the full transcript are on the Neck Trigger Points and Exercises video guide.

Lumbar Disc Herniation and Sciatica

In the lower back, L4-L5 is damaged most often, L5-S1 next and L3-L4 third. When L3-L4 herniates, I usually find other herniated levels with it.

One point in my Back Pain to Leg Pain talk surprises many people. Bending at the waist happens mostly at one level: “95% of this movement is at L4-L5”. These lower levels also take most of the body's weight in sitting and lifting. Each has its own guide: L1-L2, L2-L3, L3-L4, L4-L5 and L5-S1.

How a Lower Back Disc Causes Sciatica

Sciatica describes a symptom, not a diagnosis: the sciatic nerve is inflamed. In Sciatica vs Slipped Disc, I explain that the nerve generally forms from the L4, L5, S1 and S2 roots, with variations in some people. In the same video, I say that every case of sciatica I have seen involved the disc to some degree. That degree, as I put it, “will differ, could be from mild to moderate”. The pain, numbness or tingling usually follows one leg, and weakness can come later.

More detail is in the sciatica guide, the guide to the sciatic nerve, the leg pain guide and the lower back pain guide.

Video: Why Leg Pain Starts in the Back

In Sciatica vs Slipped Disc, I explain why leg pain so often starts in the lower back. I also explain why cracking and twisting are kept off a spine with a damaged disc, and why stretching waits until the body is ready.

Each chapter is summarized in the Sciatica vs Slipped Disc video guide.

My Talk on Disc Damage and Sciatica

Back Pain to Leg Pain is my longest talk on disc damage. It follows a disc from its anatomy and the pressure of sitting to the stages of damage. It then shows why leg pain often begins in the back. It also covers sleep positions, walking, the exercises I leave out and how surgery compares with focused conservative care.

The talk's chapters, each with a short summary, are listed on the Back Pain to Leg Pain video page.

Thoracic Disc Herniation in the Mid-Back

A herniated disc in the mid-back is rare. A clinical reference puts thoracic disc disease that causes symptoms at 0.3 to 0.8 percent of all such disc disease (Munakomi and Mesfin, 2024). Many thoracic herniations cause no symptoms at all. About three in four lie below the T8-T9 level, with T11-T12 the most common.

Pain is the most common symptom, often a dull local ache that can spread to the upper abdomen, the chest or the groin. Chest pain is always checked medically first, because the heart can cause it. A thoracic disc can also press on the spinal cord. The same reference lists these signs of cord compression:

  • Pain and altered sensation below the level of the disc.
  • Numbness and weakness in the legs.
  • An unsteady or abnormal walk.
  • Brisk reflexes and stiff, spastic legs.
  • Loss of bladder or bowel control.
  • Rarely, paralysis of the legs.

Any of these needs prompt medical assessment. New numbness around the genitals or anus, new difficulty passing urine, or loss of bladder or bowel control needs urgent medical attention at a hospital emergency department straight away, within hours. Where none of these signs is present, a thoracic herniation is cared for in the same order as elsewhere. An examination and imaging come first. Care is then focused and non-rotatory, and forceful, high-speed twisting of the mid-back is avoided.

When I see a disc bulge or herniation in the mid-back, it is often associated with an old compression fracture. I cannot say for certain which came first. Possibly the fracture came first and damaged the joints and the disc, and the disc in time gave way to its injuries and herniated.

A more serious herniation in the lower back or neck may also be present. If so, I deal with the neck and lower back first, unless the mid-back disc has caused significant compression of the spinal cord.

The people I see with a mid-back herniation already have an MRI that confirms it. When that MRI shows only the mid-back, I will often send them for MRIs of the neck and lower back as well. For a herniation high in the mid-back, which is very unlikely, an MRI of the neck is essential. Low in the mid-back, an MRI of the lower back is essential, and in the middle, both may be needed.

Care for a mid-back disc is adjusted to the region and to the person. The angles and settings differ, but the procedures are largely similar, since in general a herniated disc is a herniated disc.

What I Check When the Mid-Back Hurts

When the mid-back hurts, I check its muscles, the rib joints beside the spine and how it moves. In my experience, a herniated disc in the lower back often brings some discomfort to the mid-back as well, from about T9 to L1. The mid-back is the junction of the lumbar and thoracic spine, and the erector spinae and multifidus run through both as chains of muscle. Those muscles can tighten and guard, holding stiff to protect a painful area. When that guarding is significant, it can trouble the floating ribs, the two lowest pairs. This often settles as the lower back improves.

To tell this discomfort apart from other problems, I feel the muscles for their tone. I also press on the costovertebral joints, where the ribs meet the spine, for any tenderness. Range of motion tests complete the picture.

In older people whose bones have thinned, with osteoporosis or osteopenia, T11 to L1 needs a closer look. These vertebrae sit where the lower back's inward curve ends and the mid-back's outward curve begins. Acute or chronic compression fractures, where a weakened vertebra loses height, often occur there. I study them through imaging, examination and palpation, feeling the spine by hand. To judge whether an X-ray is needed, I place a vibrating tuning fork, 256 Hz or 128 Hz, on their spinous processes. The spinous process is the bony point at the back of each vertebra, and I note whether the vibration brings on discomfort. Once the cause is identified, care is planned for it.

When someone comes in with mid-back pain and no MRI, I assess the neck and lower back as well as the mid-back. The aim is to find where the pain comes from. If the examination suggests a compression fracture, an X-ray is enough to identify it or rule it out. Some cases go on to X-rays and an MRI, decided case by case.

An acute compression fracture, like any fracture, is outside my care. I encourage the person to see a spine surgeon, an orthopedic surgeon or a neurosurgeon, who may guide its management, surgical or non-surgical. On an MRI, the T2 images tell an acute fracture from an old one: an acute fracture shows inflammation along the fracture site. Edema, a buildup of fluid there, is the number one sign that a fracture is acute.

With an old, chronic compression fracture, care can go ahead for the problems that follow from it. These include facet hypertrophy and degeneration, thickening and buckling of the ligamentum flavum, and disc degeneration. That care addresses those problems and their symptoms, not the fracture itself.

Daily Habits That Protect a Damaged Disc

A visit covers only a small part of the day. In Sciatica vs Slipped Disc, I ask, “What about the other 22 hours?” These are the habits I ask for with a herniated disc:

  • Sitting: habits come first, then posture and the desk set-up, then an ergonomic chair, which on its own is of little value. With back pain, I advise a break every 15 to 20 minutes for 30 seconds to a minute of walking, or standing and moving. Without back pain, every 30 to 40 minutes is enough. Sit upright, with the buttocks and belt line against the back support and the screen at eye level.
  • Walking: encouraged, on level ground, in short and regular spells. Walk upright, the head above the shoulders and the eyes level, glancing down now and then for potholes. In Sciatica vs Slipped Disc, I explain that each step mobilizes the joints of the spine and depressurizes them. Walking in water is gentler than swimming laps.
  • Hills: with a disc problem, I advise against steep uphill walks, and with acute back pain, against walking uphill at all. Climbing forces a stooped, forward lean that puts more weight on the troubled levels and pushes the disc's center toward the back. The outer rings then bulge and strain toward tearing, and existing tears can widen, leading on to herniation, extrusion and, in time, fragmentation.
  • Shoes: for regular walks, two or three times a week, I advise a good running shoe, replaced every year. Most running shoes have an arch support, which walking shoes may lack.
  • Lifting: none where possible, and under 2 kg when it cannot be avoided, never while bent or twisted.
  • Bending and twisting at the waist: none, above all with weight in the hands.
  • Sleep: six hours as a minimum, ideally seven to eight hours without waking. In Neck and Back Self-Help Tips, I give my order: right side, then left side, then the back with a bolster beneath the knees. Lying on the side, use a pillow that holds the neck level with the spine, and a bolster between the knees.
  • Cold packs, not hot packs: ice in a cloth for 10 to 15 minutes, with a timer. Repeat two to three times daily, two hours or more apart. Hot packs stay off a damaged disc.
  • Left out: yoga at every stage, deadlifts and other free weights, swimming laps, general stretching, side bending, hard hamstring pulls and high-impact exercise. My Back Pain to Leg Pain talk is firm that yoga stays out even when it feels good.
  • Any activity that hurts while you do it, or leaves the pain worse within 72 hours, is stopped.

The most important step, I argue in my Back Pain to Leg Pain talk, is changing the lifestyle, not the treatment itself. In Neck and Back Self-Help Tips, I add that the time to make it is while you are hurting. The guide to posture correction for desk and office work covers the desk setup.

When Surgery Is Considered for a Herniated Disc

Surgery has its place, but in my view it comes last. In Sciatica vs Slipped Disc, I say it plainly: “Surgery should be the last option. Exhaust conservative route.” By that I mean focused conservative care, given properly. Surgery comes into view earlier only in severe cases. These include a sequestered disc, numbness around the genitals or anus, bladder or bowel trouble, and infection.

In my personal opinion, surgery often has to be repeated, and it never brings the problem to an end. When an operation is reported as 90 or 95 percent successful, I read the word success carefully. As my Back Pain to Leg Pain talk explains, success can mean any measure of improvement. A pain score falling from 10 to 9.99 would count.

One study looked at Ohio workers' compensation records for injuries in 1999 to 2001. It compared 725 people who had a lumbar fusion, an operation joining vertebrae, with 725 similar people who did not. Their diagnoses included disc degeneration, herniation and nerve root irritation (Nguyen and colleagues, 2011).

Within two years, only about a quarter of those who had fusion (26 percent) had returned to work, against 67 percent of the others. Among those who had fusion, 27 percent needed another operation and 36 percent had complications. After surgery, 76 percent were still on opioids. The study covered compensation claims only and cannot show that fusion caused these results.

The operations themselves, and their risks, are covered in the guide to spine surgery risks and non-invasive alternatives.

Some people still have pain or limited movement after spinal surgery. Care after an operation is planned around the surgical history and the imaging, with the surgeon where needed. It can include movement-based rehabilitation, physiotherapy and, where suitable, spinal decompression.

Can a Slipped Disc Heal on Its Own?

In my view, a slipped disc does not go back to the way it was. The body does notice the damage and tries to repair it, sending new blood vessels and nerves into the injured disc. The catch comes from my Back Pain to Leg Pain talk: “we're damaging it faster than our body can keep up.”

As I say in Why Spinal Discs Get Damaged, “this is a progressive condition”. Waiting to see whether a herniation settles by itself is therefore not what I advise. The load on the disc is what a person can change. Increasing what benefits it and decreasing what harms it gives care a better chance.

A disc that has herniated stays vulnerable. In Sciatica vs Slipped Disc, I explain that the prevention exercises start once symptoms improve, with the aim of keeping the problem from coming back. Without lasting changes to sitting, bending, sleep and activity, the same loads return to the same disc.

For the bigger picture, our back pain guide brings our lower back, pelvis and leg topics together in one place. For teenagers, the guide to chiropractic care for children covers disc problems in a growing spine.

Disc Stages and Causes

Neck Levels

Lower Back Levels

Care and Videos

Each fee is listed on CSC's chiropractic prices and physiotherapy fees pages. Chiropractic fees do not differ between CSC centers, and physiotherapy fees are the same at both Kuala Lumpur centers. The fee for a plan is explained and agreed before care begins.

Slipped Disc Questions Answered

Is chiropractic safe with a herniated disc?

Chiropractic care can be safe with a herniated disc, given the right method and the right checks. Is Chiropractic Safe? 13 Questions Answered gives my answer: yes, “when it's performed by a competent chiropractor who is also registered”. Beyond that, care has to match the condition. With a herniated disc, that rules out twisting the spine.

I use chiropractic manipulation that is non-rotatory using the Activator instrument, or other low-force methods. Care is kept within what you can comfortably tolerate, and possible effects and risks are explained before care begins. An assessment first rules out the urgent signs. New numbness around the genitals or anus, new difficulty passing urine, or loss of bladder or bowel control needs urgent medical attention at a hospital emergency department straight away, within hours.

Chiropractor or physiotherapist for a slipped disc?

For a slipped disc, I advise seeing both a chiropractor and a physiotherapist. Is Chiropractic Safe? 13 Questions Answered sets out why I have always paired chiropractic with physiotherapy: “Don't choose between one or the other. Choose both.” A single approach cannot be comprehensive. At CSC, chiropractors and physiotherapists plan care for a slipped disc together, from the same examination and MRI. The chiropractic side works on the joints of the spine. Physiotherapy works on strength, movement and control around the damaged level. The Chiropractic or Physiotherapy for Neck & Back guide compares the two in more detail.

Can I drive with a herniated disc?

With a herniated disc, I advise short drives with breaks. With acute, intense back pain, my rule is to drive for about 15 minutes at a time. Never go more than 20 to 30 minutes before stopping where it is safe. At each stop, get out and walk; once the acute phase has passed, a gentle calf stretch can be added. Long road trips should wait while the disc is irritable. If a trip cannot wait, travel as a front-seat passenger with the seat reclined. A car seat loads the disc much as a desk chair does, so support the lower back. If driving brings on leg numbness or weakness, stop and have it checked.

Are steroid injections an option for a slipped disc?

I do not recommend steroid injections. In Sciatica vs Slipped Disc, I list what people are often offered: cracking, a hard neck pull, steroid injections or a little surgery. My answer: “I wouldn't recommend any of those.” Focused conservative care comes first. New numbness around the genitals or anus, new difficulty passing urine, or loss of bladder or bowel control needs urgent medical attention at a hospital emergency department straight away, within hours.

In my personal opinion, nucleoplasty, a needle procedure into the disc, has no value either. I have seen hundreds of patients, if not more, who did not improve after it, and many grew worse. If an invasive procedure is ever needed, I recommend avoiding radiofrequency nucleoplasty and facet joint injections. For arm pain from a herniated neck disc, a Cochrane review judged the evidence too thin to support nucleoplasty (de Rooij and colleagues, 2025).

Can an MRI show disc damage without pain?

An MRI often shows disc damage in people who feel no pain. My Back Pain to Leg Pain talk puts it bluntly: “the most common symptom of spinal disc damage is zero.” The same talk describes damage that, by its appearance on the scan, had been there for decades before any pain. A scan finding therefore has to match the examination before it is treated as the cause. Even so, the damage matters, because in my view it is progressive. As I put it in that talk, “Once you have a damaged disc, it can go rapidly or it can take years.”

Can I go to the gym with a damaged disc?

With a damaged disc, the gym is discouraged at first, and free weights stay out for two to six months. Once the spine is stable, a few machines can return at light loads. These are leg curl and leg extension, adductor and abductor machines, lat pulldowns, light rows and, for some people, chest press. Free weights, deadlifts and the leg press remain off the list. On the treadmill, the incline stays at zero, since any slope loads the lumbar discs more. In my Back Pain to Leg Pain talk, I advise against deadlifts in particular.

How to Read This Guide

The first person marks my own views. When a view comes from a video or talk of mine, I name it. Each study appears by first author and year, with its full citation in the reference list. Each describes groups of people rather than any single person's disc. Nothing here is a diagnosis; only an examination can judge your own herniated disc.

References

  • Costa L, de Reuver S, Kan L, et al. Ossification and fusion of the vertebral ring apophysis as an important part of spinal maturation. J Clin Med. 2021;10(15):3217.
  • de Rooij JD, Verhagen AP, Harhangi BS, et al. Nucleoplasty for cervical radicular pain due to disc herniation. Cochrane Database Syst Rev. 2025;11:CD011852.
  • Munakomi S, Mesfin FB. Thoracic discogenic syndrome. In: StatPearls. Treasure Island (FL): StatPearls Publishing; updated March 20, 2024. NCBI Bookshelf NBK470388.
  • Nguyen TH, Randolph DC, Talmage J, Succop P, Travis R. Long-term outcomes of lumbar fusion among workers' compensation subjects: a historical cohort study. Spine (Phila Pa 1976). 2011;36(4):320-331.
  • Shealy CN, Borgmeyer V. Decompression, reduction, and stabilization of the lumbar spine: a cost-effective treatment for lumbosacral pain. Am J Pain Manage. 1997;7:63-65. Preliminary findings; no PubMed record.
  • van Middelkoop M, Rubinstein SM, Verhagen AP, et al. Exercise therapy for chronic nonspecific low-back pain. Best Pract Res Clin Rheumatol. 2010;24(2):193-204.

None of these studies looked at the care given at Chiropractic Specialty Center.

The Author of Herniated Disc Treatment in KL: Neck, Back and Surgery

Herniated Disc Treatment in KL: Neck, Back and Surgery was written by Yama Zafer, D.C., who has 30+ years in chiropractic and physiotherapy and founded Chiropractic Specialty Center in Kuala Lumpur in 2006.

Last Updated: Herniated Disc Treatment in Kuala Lumpur: Signs, Causes and Care

Herniated Disc Treatment in Kuala Lumpur: Signs, Causes and Care was last reviewed and updated on October 16, 2026.

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