Non-Operative — Lumbar Disc Displacement / Herniation (Non-Operative)

Massachusetts General Hospital · MGH Sports Medicine

Weight-Bearing

WBAT; avoid prolonged sitting and flexion-biased positions; light bracing may help Phase I

Key Restrictions

Limit sitting; avoid activities/positions that worsen symptoms (flexion>extension); controlled shift/extension to neutral; consider ESI referral if unable to sit for short periods with continued lower leg symptoms after 10-day NSAID course; monitor neurologic signs throughout; bracing discontinued Phase III

Timeline & Phases

4 phases: Phase I (0-6 wks, 6-8 visits — ice/e-stim, self-traction, controlled extension to neutral, STM paraspinals, manual/mechanical traction, local TA/MF core — TA with heel slides/arm movements, walking short distances frequently), Phase II (6-12 wks, 8-10 visits — hip/thoracic mob, dead bug, bird dog, standing partial squats; ESI referral if needed; sit 20 min with neutral spine by end), Phase III (12-16 wks, 4-6 visits — anti-rotation, deadlifts, overhead press, plyometrics, return to run; bracing discontinued), Phase IV (16+ wks, optional — sport-specific with lumbopelvic control)

Notes

March 2025; for acute to subacute single-level disc herniation in 25-55 year old population; centralization concept used — ideally no symptoms below knee by end Phase I; reassuring language about body's ability to heal emphasized; ESI consult recommended if not improving by Phase II; front plank 40 sec and side bridge 40 sec required for Phase III. [Archived copy — original Massachusetts General Hospital URL retired in the Mass General Brigham site migration; Wayback snapshot 2025-11-22.]

Surgeon / Author

MGH Sports Medicine

Published

March 2025