I Have A Bulging Disc On My Back. Do I Need Surgery?
By Mark Howlin
Associate Physiotherapist, Musculoskeletal & Sports Injuries (BSc, MSc, GEMt) · Registered with the AHPRA (PHY0004060355)
Mark Howlin is an Associate Physiotherapist at Physio K, with a focus on sporting injuries and post-operative rehabilitation, with advanced dry needling training from Ireland and Sydney. Across six years of clinical practice in Ireland and Australia, he has developed particular experience in chronic conditions such as anterior knee pain and Achilles tendinopathy, and acute lower limb muscle strains, using an integrated approach combining manual therapy, dry needling, and progressive rehabilitation. He has also served as team physiotherapist to elite GAA athletes, including during a championship-winning run at Croke Park
Last reviewed: 04 November 2026
A bulging disc does not usually require surgery. Many people improve with time, activity modification, exercise-based physiotherapy and appropriate medical care. Surgery is generally reserved for cauda equina syndrome (a rare emergency affecting bladder and bowel control), progressive or severe weakness, or persistent disabling nerve pain.
Key Takeaways
Many people with disc-related pain improve without surgery over weeks to months, with activity modification, exercise and time
Surgery becomes relevant when there is severe or worsening weakness, cauda equina syndrome, or persistent disabling nerve pain after appropriate conservative care
Scan findings are a poor guide to pain levels: many people have disc changes on MRI without symptoms
Conservative care, including exercise-based physiotherapy, is generally the first step, with surgery considered if symptoms stay severe or worsen
Seek urgent emergency care or call 000 for new loss of bladder or bowel control, numbness in the saddle area (around the genitals, buttocks or inner thighs), or rapidly worsening leg weakness
What is actually happening in your back?
The spine contains cushioning discs that sit between the bones and allow movement. A bulging disc means the outer layer of one of these cushions has weakened or expanded outward, but the inner gel-like centre remains contained. This is different from a herniated disc, where the inner material pushes out through the outer layer and may press on a nearby nerve.
Discs have a limited blood supply, but their outer layer has nerve endings, and inflammation around a disc can irritate nearby nerves, which is why disc problems can be painful. What the scan shows and what you feel often don’t match: disc changes are common on MRI in people without symptoms, so your pain, strength, sensation, reflexes and what you can and can't do matter far more than the image alone.
Surgery is a common question, often shaped by other people’s experiences. Every case is different, and there is no one-size-fits-all answer to disc pain.
Can disc bulges get better on their own?
Symptoms from a disc problem often improve over weeks to months, and the disc material itself sometimes shrinks on follow-up scans. A 2023 systematic review in the Journal of Neurosurgery: Spine reported spontaneous regression in about 13.3 per cent of bulging discs, 52.5 per cent of protrusions, 70.4 per cent of extrusions and 93.0 per cent of sequestrations (larger or more displaced herniations).
"One of the biggest myths I come across is that a disc problem never gets better without surgery,” says Mark Howlin, Associate Physiotherapist at Physio K. “Disc bulges and herniations can change over time, and symptoms often settle. It depends on the person and their symptoms, so a proper assessment matters.”
Remaining appropriately active, gradually restoring normal movement and following an individualised exercise program are usually preferred to prolonged bed rest. When you avoid all movement because you're scared of making it worse, stiffness, fear and loss of confidence can build, which may make the problem harder to shift.
What does the research say about surgery and conservative care?
The Japanese Orthopaedic Association clinical guidelines, published in 2022, state that conservative treatment is generally first-line because symptoms may improve with time, while early surgery is considered for cauda equina syndrome or severe and worsening motor deficits. The guideline also notes that high-level evidence for conservative treatments is limited.
The decision about surgery depends on your symptoms, examination findings and scan results together, and is made with your GP or a spinal specialist.
When does surgery become the right option?
Surgery may provide faster relief for carefully selected people with persistent, disabling leg pain caused by confirmed nerve compression. It becomes more urgent when weakness is severe or worsening, or when cauda equina syndrome is suspected.
Warning symptoms that require emergency medical assessment, not routine physiotherapy, include new difficulty passing urine, loss of bladder or bowel control, numbness around the saddle area (the area that would touch a bicycle seat), or rapidly progressive leg weakness. The Australian Commission on Safety and Quality in Health Care Low Back Pain Clinical Care Standard, published in 2022, recommends immediate emergency referral for suspected cauda equina compression, spinal infection or acute severe neurological deficit, with prompt GP review or imaging if cancer or a fracture is suspected.
If symptoms remain severe despite appropriate conservative care, a GP or spinal specialist can discuss whether surgery's potential benefits outweigh its risks. Surgery doesn't always fully relieve symptoms, and doesn't prevent the injury recurring. As with any surgery, there are risks to weigh up, including infection, nerve damage, and other potential complications, as well as the recovery time and cost involved.
What you can do while symptoms settle
Keep moving within tolerable limits and avoid prolonged bed rest. Gentle walking and graded exercise help preserve function. Seek assessment if pain is worsening or preventing basic activities such as getting dressed, walking to the bathroom, or making a cup of tea.
Arrange a physiotherapy or GP assessment for leg pain, tingling, numbness or weakness, and see your GP promptly for new numbness or weakness. The clinician can check neurological function and develop a graded program, with referral if findings are concerning. Use lifting and work modifications temporarily rather than stopping all activity. Change positions regularly and build back towards normal duties as symptoms settle.
“When I assess someone with disc-related back or leg pain, I start by listening: what they think is happening, what they’ve been told before, what they’ve tried, and what worries them about it. I then examine their back and legs, checking movement, strength, sensation and reflexes, and, where it is safe and appropriate, begin hands-on treatment in the same session. Listening first gives me a fuller picture of what may be feeding the problem, which can be more than one thing. That’s why the plan can go beyond exercises and may include advice on adjusting how you move and work day to day, alongside targeted rehabilitation” says Mark
At Physio K, treatment typically combines manual therapy, including joint mobilisation and soft tissue work, with progressive exercise tailored to your symptoms and goals, built around what you need to get back to, whether that’s work, sport or moving through your day with confidence. You can book an assessment online.
Common Questions
Why is my leg numb or painful if the scan says only a bulge?
A bulge can irritate a nerve without completely compressing it, causing pain, tingling or numbness down the leg. The nerve doesn't have to be fully squashed to produce symptoms. Sometimes inflammation around the disc is enough to sensitise the nerve, and sometimes the pain is coming from other structures in the back rather than the disc itself. Your symptoms, strength and reflexes tell us more about what's happening than the scan alone.
Can I return to work, sport or lifting?
Often, yes, with modifications and build back gradually as symptoms settle. For work, change positions regularly, use lifting aids where available, and discuss temporary adjustments with your employer if needed. For sport, a graded return guided by your symptoms is safer than jumping straight back to where you left off. Lifting technique matters, and a graded return can help you rebuild confidence. A physiotherapist can help you work out what's safe now and how to progress.
How many sessions will I need?
Most people notice improvement over weeks to months with appropriate care. The timeline varies depending on the severity of symptoms, how long the problem has been present, and how well you can follow the rehabilitation program. Some people feel better within a few weeks, others take longer. Progress isn't always linear, flare-ups can happen, but the overall trend should be towards improvement, but see your GP if symptoms are getting worse.
If back or leg pain is affecting your day, book an assessment with Physio K or contact the clinic to talk it through. If you have any of the warning signs listed above, seek urgent medical care first.
Reviewed by Kenny Merlevede. Kenny Merlevede is a Senior Physiotherapist with 18 years of experience in private practice, with a focus on complex cervical presentations and persistent musculoskeletal conditions. Registered with the Australian Health Practitioner Regulation Agency (PHY0002060505).
This article is for general information only and is not a substitute for personal medical advice. If you have concerns about your health, please consult a qualified clinician or your GP.
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