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Leg pain related to a Disc wall bulge / Slipped disc

Symptoms of leg pain related to Disc bulging / Slipped Disc.

Shooting (lancinating) pain in to the leg ± pins & needles / numbness ± muscle weakness affecting the leg
Low Back pain ± buttock pain
Aggravated by flexion / extension of the back,
± coughing / lifting
eased by lying down.
No associated systemic disease such as cancer.
No or limited slippage of one vertebra upon the next.
No disturbance of sphincter function or loss of sensation in the perineum

Presentation	Diagnosis	Options
First episode <6 weeks duration	Muscle strain or facet joint strain	Muscle Balance Physiotherapy
First episode <6 weeks duration	Prolapsed disc irritating the local nerve	Muscle Balance Physiotherapy, anti-inflammatory medicines, pain controlling medicines (Conservative Care)
First Episode >6 weeks duration NOT responding to Muscle Balance Physiotherapy	Prolapsed Disc irritating the local Nerve ± High Intensity Zone or disc leaking pain producing products	MRI Scan advised Further Conservative care + increased analgesia, Nerve root blocks, Caudal epidural injections, Facet Joint Injections. (Chronic Pain Management)
Recurrent repeated episodes Failed Chronic Pain Management	Prolapsed Disc irritating the local Nerve ± High Intensity Zone or disc leaking pain producing products	Endoscopic Lumbar Decompression & Foraminoplasty / Microdiscectomy.
Worsening signs of weakness or numbness ± lessening back pain	Increasing size of prolapse with nerve root	Endoscopic Lumbar Decompression & Foraminoplasty / Microdiscectomy