You just got the MRI results: herniated disc, lower back, somewhere around L4-L5 or L5-S1. Your first thought? Surgery. Months off your feet. Maybe never getting back to the gym, picking up your kid without wincing, or sitting through a full workday again.

But here's what that MRI report doesn't tell you. A 2025 systematic review published in Frontiers in Medicine found that nearly 60% of conservatively treated lumbar herniations actually shrink on their own — a process called disc resorption. Physical therapy for a herniated disc in the lower back doesn't just manage symptoms. It's the engine that drives that recovery forward.

This guide breaks down exactly how PT treats lumbar herniations, what your recovery looks like phase by phase, which exercises are safe (and which ones make things worse), and how therapy stacks up against surgery. Everything here is specific to the lower back — because that's where your pain is, and that's what matters.

Can Physical Therapy Fix a Herniated Disc in Your Lower Back?

Physical therapy is the recommended first-line treatment for herniated discs in the lower back. Research shows that 70–90% of lumbar disc herniations improve without surgery. PT reduces pain, restores mobility, and supports the body's natural disc resorption process, with most patients seeing measurable improvement within 2–6 weeks of starting a structured program.

Now, "fix" deserves some honesty. PT won't push the disc back into place overnight. What it does is reduce the inflammation around the herniation, take pressure off the compressed nerve, and strengthen the muscles that stabilize your lumbar spine — so your body can heal itself. That's not a consolation prize. Long-term outcomes for PT and surgery are remarkably similar at the 1–2 year mark, according to data from the NCBI's StatPearls clinical reference (updated September 2025).

After treating over 5,000 patients at our clinics, we've seen this pattern repeat: someone walks in convinced they need surgery, starts a targeted rehab plan, and within weeks they're moving better than they have in months. Not every case plays out identically, but the majority do respond to conservative care. Fewer than 10% of lumbar disc herniation patients actually need surgical intervention within the first six weeks.

The real question isn't if PT works for lower back herniations. It's what kind of PT — and that depends on where your herniation is.

Why Lower Back Herniations Are Different (L4-L5 and L5-S1) 

Not all herniated discs are the same, and this is where most articles fall short. About 95% of lumbar disc herniations occur at just two levels: L4-L5 and L5-S1 (Cai et al., as cited in ScienceDirect research on disc herniation patterns). Each level compresses different nerve roots, which means different symptoms — and a different rehab focus.

L4-L5 herniation typically compresses the L5 nerve root. You'll often feel pain radiating from the lower back into the outer thigh and down toward the top of the foot. Weakness in lifting your foot upward (called foot drop in severe cases) is a telltale sign. When we see this presentation, the PT approach prioritizes nerve gliding techniques and extension-based exercises to reduce the pressure at that specific level.

L5-S1 herniation usually affects the S1 nerve root. Pain tends to shoot down the back of the leg, through the calf, and into the heel or sole of the foot. You might notice a weakened ability to push off when walking or difficulty standing on your toes. This is the most common pattern we treat — classic sciatica driven by the lowest lumbar disc.

Here's why this matters for your rehab: a generic "herniated disc exercise list" doesn't account for which nerve root is involved. An exercise that helps an L4-L5 patient might aggravate an L5-S1 case if the movement loads the spine differently. That's why individualized assessment at the start of PT isn't optional — it's the foundation your entire recovery plan is built on.

What Your Lumbar Herniated Disc PT Program Looks Like 

Recovery from a lower back herniated disc follows a predictable framework, even though the pace varies person to person. After 15+ years of treating lumbar herniations at our Victor, Brighton, Greece, and Cortland locations, we use a four-phase approach that maps to how disc tissue actually heals.

Phase 1: Pain Relief and Protection (Days 1–14)

The first priority is reducing acute pain and calming the irritated nerve. Your therapist will likely use a combination of manual therapy, positioning strategies, and gentle movement. Bed rest? Only for a day or two at most. The American Association of Neurological Surgeons recommends limiting strict rest to 2–3 days — beyond that, inactivity weakens the muscles that your spine depends on.

During this phase, you'll learn which positions reduce your symptoms (often lying with knees supported) and which movements to avoid temporarily. Walking is encouraged as tolerated. The goal isn't to push through pain — it's to keep your body moving within a safe window.

Phase 2: Mobility Restoration (Weeks 2–6)

As inflammation settles, your PT introduces gentle stretches and mobility work targeting the lumbar spine, hips, and hamstrings. Tight hamstrings pull on the pelvis and increase disc pressure — a connection that surprises most patients.

This is also when McKenzie-based extension exercises often enter the picture. The McKenzie method focuses on "centralizing" your pain — moving it from the leg back toward the spine, which signals reduced nerve compression. When we see pain centralizing, that's a strong indicator you're on track.

You'll notice less radiating pain, improved ability to sit and stand, and a gradual return to daily tasks.

Phase 3: Core Strengthening (Weeks 6–12)

Once pain is manageable, the work shifts to rebuilding the stability your lower back needs. Core stabilization isn't just about abs — it's the coordinated effort of your deep spinal muscles, glutes, hip stabilizers, and pelvic floor.

This phase is where disc resorption research becomes relevant. That 59% resorption rate from the 2025 Frontiers in Medicine review isn't magic — it happens when the body's inflammatory response gradually absorbs the herniated material. Strengthening the muscles around the disc supports this process by reducing mechanical stress on the healing tissue.

Exercises progress from controlled isometrics (like bird-dogs and modified planks) to functional movements that mimic your daily life.

Phase 4: Return to Activity (12+ Weeks)

The final phase bridges you back to the activities you love — whether that's lifting weights, playing with your kids, running, or getting through a full day at a desk job without pain. Your therapist tests your readiness with sport-specific or work-specific movement patterns and adjusts as needed.

The part nobody mentions: this phase matters as much as the first three. Patients who skip it are the ones who re-herniate six months later. A structured return-to-activity plan reduces recurrence and builds long-term resilience.

Safe Exercises for a Herniated Disc in Your Lower Back

Not every exercise helps a lumbar herniation — and some popular ones make things significantly worse. These are the PT-approved movements we use most often, along with the clinical rationale behind each.

1. McKenzie Press-Up (Prone Extension)

Lie face down, place hands under shoulders, and gently press your upper body up while keeping hips on the floor. Hold 2–3 seconds, lower, repeat. This helps shift disc material away from the nerve root — the cornerstone of the McKenzie method for lumbar herniations.

2. Pelvic Tilts

Lie on your back with knees bent, feet flat. Gently flatten your low back against the floor by tightening your lower abs. Hold 5 seconds. This activates deep core muscles without loading the disc.

3. Bird-Dog

Start on hands and knees. Extend one arm and the opposite leg while keeping your spine neutral and core engaged. Hold 5–10 seconds. This builds lumbar stability through the transverse abdominis and multifidus — the muscles closest to your spine.

4. Hamstring Stretches

Lie on your back and straighten one leg toward the ceiling (use a towel behind the thigh if needed). Hold 20–30 seconds. Tight hamstrings increase pull on the pelvis and amplify lower back stress. Loosening them takes indirect pressure off the disc.

5. Cat-Cow

On hands and knees, slowly alternate between arching your back (cow) and rounding it (cat). Move gently through whatever range feels comfortable. This restores spinal mobility and reduces stiffness without end-range loading.

6. Walking

It sounds simple because it is. Walking promotes blood flow to the healing disc, maintains hip and spine mobility, and activates stabilizing muscles without compression. Start with 10–15 minutes and build gradually.

Exercises to Avoid

These movements increase lumbar disc pressure or force the spine into positions that worsen nerve compression:

• Sit-ups and crunches — load the lumbar spine in flexion
• Toe touches (standing or seated) — stretch pulls directly on the disc
• Heavy deadlifts and squats — axial loading during acute phase
• Russian twists — rotational shear on the herniation
• Running — high-impact jarring before adequate stabilization

The issue with most "herniated disc exercise" lists online is they don't tell you when each exercise is appropriate. A bird-dog at week 6 is great. That same bird-dog on day 3 of acute sciatica might flare you up. Timing and progression matter more than the exercise itself.

Physical Therapy vs. Surgery for Lumbar Herniated Discs

This is the comparison most patients are really searching for. Here's what the research shows when you put them side by side:

Factor	Physical Therapy	Surgery (Microdiscectomy)
Pain relief timeline	Gradual over 2–6 weeks	Often immediate post-op
Long-term outcomes (1–2 years)	Similar to surgery	Similar to PT
Recovery restrictions	Active throughout treatment	4–6 weeks of activity limits
Risks	Minimal (temporary soreness)	Infection, nerve damage, re-herniation
Cost	Lower (PT visits, no facility fees)	Higher (surgeon + facility + anesthesia)
Invasiveness	Non-invasive	Minimally invasive surgery
Recommended when	First-line for most patients	After conservative care fails or severe neurological deficits

The takeaway: surgery provides faster initial pain relief, but by the 1–2 year mark, patients who chose physical therapy for a herniated disc report similar outcomes. That's why clinical guidelines consistently recommend PT first. A 2025 retrospective analysis of over 3,000 patients published in the Journal of Clinical Medicine confirmed that conservative treatment achieved meaningful improvement in the majority of cases, with about 25% of initially conservative patients eventually transitioning to surgery.

Surgery becomes the right choice when you have progressive neurological deficits (worsening weakness, loss of bowel or bladder control) or when 6–12 weeks of committed PT hasn't produced improvement. That combination — clear neurological emergency OR confirmed failure of conservative care — is the standard surgical threshold, per AAOS and APTA guidance.

For most patients? PT is the safer, lower-cost starting point. And it works. That's why many of our Rochester and Brighton patients begin with therapy and never need to see a surgeon at all.

When to Start PT for Your Lower Back Herniated Disc

Sooner than you think. Most clinical protocols recommend starting physical therapy within days of diagnosis — not weeks. Early PT leads to better outcomes, shorter recovery timelines, and lower risk of the problem becoming chronic.

Here's what to expect at your first visit: your therapist will assess your movement patterns, test nerve function in your legs, identify which lumbar level is involved, and build your individualized plan. No two lumbar herniations are treated the same, which is why cookie-cutter exercise sheets don't cut it.

Red flags that need immediate medical attention (not PT first): Call your doctor or go to the ER if you experience sudden loss of bowel or bladder control, rapidly worsening weakness in both legs, or numbness in the groin area. These symptoms may indicate cauda equina syndrome — a rare but serious condition that requires emergency surgical evaluation.

Outside of those emergencies, physical therapy for a herniated disc in your lower back is where recovery starts. Whether your herniation is at L4-L5 or L5-S1, whether you're 32 or 58, the pathway is the same: get evaluated, get a plan, and get moving.

Frequently Asked Questions

How long does physical therapy take for a herniated disc in the lower back?

Most patients notice improvement within 2–6 weeks of consistent PT. Full recovery — meaning return to normal activity levels — typically takes 3–4 months. Severe cases or patients with significant nerve involvement may need longer, but progress is usually steady with an individualized plan. At Limitless PT, we adjust timelines based on your specific herniation level, activity goals, and how your body responds.

Can a herniated disc in the lower back heal on its own without surgery?

Yes. Research shows that 70–90% of lumbar disc herniations resolve with conservative treatment. A 2025 study found that 59% of conservatively managed herniations show measurable disc resorption — the body actually reabsorbs the herniated material. Physical therapy accelerates this process by reducing inflammation, restoring mobility, and strengthening spinal stabilizers.

What exercises should I avoid with a lumbar herniated disc?

Avoid sit-ups, crunches, toe touches, heavy deadlifts, Russian twists, and running until your therapist clears you. These movements increase pressure on the lumbar discs or force the spine into positions that worsen nerve compression. Your PT will tell you when it's safe to reintroduce each one based on your recovery stage.

Is it safe to walk with a herniated disc in my lower back?

Walking is one of the best things you can do. It promotes blood flow to the healing disc, maintains hip and spine mobility, and activates stabilizing muscles — all without adding significant compression. Start with short walks (10–15 minutes) and increase gradually. If walking worsens your leg pain, shorten the distance and talk to your physical therapist.

Physical therapy for a herniated disc in your lower back isn't a backup plan — it's the first-line treatment that helps most people avoid surgery, reduce pain, and get back to the activities that matter. Whether your MRI says L4-L5 or L5-S1, the next step is the same: get evaluated, get a plan that fits your body and your goals, and start moving forward.

You don't have to live with this limitation. Many of our Victor, Brighton, Greece, and Cortland patients discovered they could return to full activity with nothing more than structured physical therapy and consistency.

👉 Ready to live a life without limits? Schedule your evaluation and start doing the things you love — with the people you love.

About the Author

Dr. Dan Bajus, PT, DPT Dr. Bajus is the founder of Limitless Physical Therapy Specialists with over 15 years of clinical experience treating orthopedic conditions, spine injuries, and sports-related pain. He has treated over 5,000 patients across four New York locations — Victor, Brighton, Greece, and Cortland — and is committed to helping every patient move, feel, and live without limits.