Back & ribs
Lumbar disc herniation
How to put an MRI finding in context
What it means
A lumbar disc herniation describes disc material extending beyond its usual boundary. It can irritate a nearby nerve root and contribute to leg symptoms. Disc findings also appear on scans of people without pain, so side, level, symptoms, and the neurological exam need to line up. [1, 2]
What I check in the clinic
I ask how sitting, coughing, walking, or bending changes what you feel. If you came in because your calf tingles after driving, I check whether a clinic movement recreates it, then see what changes with a different position. Strength changes guide when another clinician should be involved.
What the evidence says about care
Some herniations shrink over time. A review found surgery for selected people with sciatica could relieve leg pain faster, with smaller average differences over time. Progressive weakness or other neurological findings can change the timing of surgical assessment. [3, 4, 5]
Common questions
Why does the MRI describe my back when the pain I notice is in my calf?
I’d ask where the feeling starts and travels and compare that with the side and level described on the scan and what we find on exam. Together those details help us judge how well the report fits.
The scan hasn’t changed. How can I tell if I’m doing better?
We can compare how long you sit, where the symptoms go, and how you feel when you get up. Those observations help us track what is changing in your day.
Why is the ride home harder than walking once I get there?
I’d ask when the symptoms begin on the drive and what walking changes. If sitting brings on the same feeling in the clinic, we can compare that position with a small adjustment.
What if the scan finding is on the opposite side from my symptoms?
That’s worth pointing out. I’d compare the report with where you feel symptoms and what we see in the exam before drawing a conclusion about how they fit.
When should I go straight to the emergency department?
With back or leg pain, go to the emergency department for new numbness around the genitals or anus, new trouble urinating or controlling your bladder or bowels, or severe or worsening weakness or numbness in both legs. [6]
What should I bring to an evaluation?
Bring one example of a movement or activity you want back, along with any relevant imaging or treatment notes you already have.