A disc herniation can cause neck pain, back pain, sciatica, arm pain, leg pain, numbness, tingling, or weakness when disc material irritates or compresses a nerve root. But a herniated disc on MRI is not always the true pain generator. Manhattan Pain Medicine uses a diagnosis-first approach to determine whether symptoms are coming from the disc, a nerve root, the sacroiliac joint, facet joints, spinal stenosis, inflammatory back pain, hypermobility-related instability, or another overlapping pain source.
Learn how Dr. Siefferman explains disc herniations, their role in back and nerve pain, and personalized treatment options to help patients find lasting relief.
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Hi, I’m Dr. Jason Siefferman, medical director at Manhattan Pain Medicine and interventional pain specialist. Disc herniations affect almost everyone at some point in life. If you’ve ever had a stiff neck or stiff back for a few weeks, that was likely a disc herniation. Disc herniations occur either because a primary trauma like a car accident or bending and lifting at the gym or from repetitive stress to that same disc over time where it gradually causes a wear and tear to that disc. What happens is the fibrous ring called the annulus either tears, sprains, stretches, bulges so that the disc material in the inside leaks out or it contacts a nerve. The pain presenting from disc herniations may be either from the disc itself or from the nerves irritated by that disc or the muscle guarding this whole process. Whenever there is a disc herniation, the body’s natural response is to tighten up and guard, which is why people present with a stiff neck or stiff back.
When we think about a disc herniation, we think about it like an ankle sprain. That that fibrous ring has sprained, that disc material has come out, it must be stabilized. So very much like you might wrap an ankle and stay off of it so that it can heal. When we have a patient who has a disc herniation, the first step is to understand why it happened. Was it a singular trauma or was there repetitive stress? If there’s repetitive stress, we really have to unwind that biomechanical pattern so they don’t continue to provide that stress to the disc. Otherwise, the disc will never heal.
Physical therapy for disc herniation really has two goals. One is to strengthen the stabilizing muscles of the spine. This is so that the force that’s applied to the spine isn’t just repetitively occurring at one level, but it’s distributing across multiple levels so that that force is shared so that there’s less force to any one specific disc. The second thing physical therapy does is it trains biomechanical patterns or retrains them.
When disc herniations are persistent causing severe pain or when there’s leakage of that disc material onto the nerve causing significant nerve pain, we talk about an epidural. An epidural is an injection into the spine where we inject fluid into that space where the disc has herniated to the nerve. What the fluid does is it washes that disc material off of the nerve and it provides a steroid to calm the nerve down. What we expect from the first epidural is anywhere to 40 to 60% improvement. Each epidural takes about 2 weeks to fully settle in. We re-evaluate at that time and then we decide if the second one is necessary. We understand how disc herniations happen, why they happen, the spectrum of treatment options, and we’ll work with you to determine the path that you think is best and will work best for you to get you the most durable relief.
A disc herniation happens when the soft inner portion of a spinal disc pushes through the outer layer of the disc. Disc herniations are sometimes called slipped discs, ruptured discs, or herniated discs. They most often occur in the lower back, but they can also occur in the neck.
Some disc herniations irritate or compress nearby nerve roots. When this happens in the lower back, symptoms may travel into the buttock, leg, or foot. When it happens in the neck, symptoms may travel into the shoulder, arm, hand, or fingers. Patients may describe sharp pain, burning pain, electric pain, numbness, tingling, pins and needles, or weakness.
At the same time, not every disc herniation causes pain. Some people have disc herniations on MRI that are incidental. MPM evaluates disc herniations by correlating symptoms, physical exam findings, neurologic signs, imaging, pain pattern, hypermobility context, inflammatory disease risk, and treatment response.
For patients searching for herniated disc treatment in Manhattan or NYC, MPM focuses on identifying whether the disc herniation is truly driving symptoms or whether another pain generator is involved.
A herniated disc may cause sciatica, lumbar radiculopathy, cervical radiculopathy, arm pain, leg pain, numbness, tingling, or weakness. But similar symptoms can also come from spinal stenosis, sacroiliac joint dysfunction, facet-mediated pain, spondylolisthesis, spondylosis, inflammatory back pain, piriformis-region irritation, peripheral nerve entrapment, hypermobility-related instability, EDS, or chronic pain sensitization.
MPM’s role is to interpret the full picture before treatment is selected. Care may include medication management, rehabilitation coordination, acupuncture, Feldenkrais, biofeedback, pain psychology, epidural injections, spine injections, steroid injections, epidural lysis of adhesions, regenerative options in selected non-disc pain patterns, spinal cord stimulation, dorsal root ganglion stimulation, or referral for surgical evaluation when appropriate.
Many patients arrive with an MRI report that says disc herniation, bulging disc, degenerative disc disease, spinal stenosis, spondylosis, or spondylolisthesis. These findings matter, but they do not automatically prove the source of pain.
A disc herniation is most clinically meaningful when the imaging finding matches the symptom pattern, neurologic exam, nerve distribution, and functional limitation. For example, a lumbar disc herniation may be more suspicious when pain travels down the leg in a nerve root pattern with numbness, tingling, reflex change, or weakness. A cervical disc herniation may be more suspicious when neck pain travels into the arm or hand in a consistent nerve distribution.
MPM evaluates the disc finding in context. The goal is not to treat the MRI. The goal is to identify the pain generator.
Disc herniations can be more complex in patients with hypermobility, Ehlers-Danlos syndrome, recurrent sprains, joint instability, or altered movement mechanics. In these patients, pain may involve more than the disc alone. The spine, sacroiliac joints, facet joints, ligaments, muscles, and nervous system may all contribute.
MPM evaluates disc herniations through both a musculoskeletal and hypermobility-aware lens. The care plan is based on the patient’s mechanics, neurologic findings, pain generator, stability pattern, inflammatory context, and functional goals.
These guys are the best. I've been going here for over 6 years and their familiarity with my Schwannomatosis (most ppl have never even heard of it - its rather rare) and their ability to diagnose my CRPS quickly and accurately and then treat it like I was merely getting a flu shot is just incredible...
Highly recommended for those who need Pain Management. Everyone at Manhattan Pain Medicine is extremely nice and helpful. I have had very good interactions with both Dr. Siefferman and Dr. Louis. All of the staff is very responsive. 5 stars.
The providers at Manhattan Pain Medicine are exceptional. I wish I had found them 30 years ago!
I genuinely can’t say enough good things about the team at Manhattan Pain Medicine. I have MCAS, EDS, and an inflammatory autoimmune disease, and I’ve basically been searching for answers since I was a kid. I had years of unexplained inflammation markers, chronic pain, and allergic reactions despite...
I have a complex medical history and have seen a lot of doctors over the years. Dr. Mikaberidze and Dr. Siefferman each took the time to really listen and understand everything I had been dealing with. I also appreciated how they work together and communicated about my care. I left with a plan that...
Sharing my gratitude for the pleasant experience last week during my visit, the medical team provided great care and also treated my session as a learning experience, I left my session with a wealth of knowledge. A big thank you to the kind, and professional staff who welcomed me to the office as a...
I cannot say enough good things about Manhattan Pain Medicine. From the moment I walked in, I felt truly cared for and taken seriously. Dr. Nino Mikaberidze, Director of Rheumatology, is exceptional — knowledgeable, compassionate, and incredibly thorough. She takes the time to listen, explains every...
Dr Siefferman is the most thorough, patient doctor I have even been to. Currently I travel from miami to nyc to see him because his bed side manner and desire to help is incomparable.
ZocDoc
This practice is wonderful. I have been a patient of Dr. Siefferman’s since 2019 and he’s extremely helpful and kind. He has brought in a Rheumatologist who is also great. They handle very complex pain issues and always try to find new ways to help me.
Dr. Siefferman is an incredible doctor! He is extremely diligent and knowledgeable. It feels like you are his only patient. He invests a lot of time and effort into your injuries and concerns. I did not find these wonderful qualities with other pain specialists before, who were always rushed and som...
ZocDoc
Dr. Siefferman is a doctor who combines the old world bedside manner of doctors from my childhood (60 years ago) with a sta te of the art embrace of modern technology. It is always a pleasure to have an appointment with him...always has options and solutions to my medical issues. He is truly the doc...
ZocDoc
Dr. Siefferman is a genius. He is very informed and listens attentively.
ZocDoc
Dr. Siefferman and his entire team continue to be efficient, dedicated, and driven by precision and a genuine desire to give fantastic care. Will always recommend.
ZocDoc
Doctor Siefferman is fantastic. Have been seeing him for 5 years. Couldn’t recommend more.
ZocDoc
Dr. Siefferman is the ONLY doctor who has ever been able to diagnose my pain and treat it. He is hands down the best
ZocDoc
A disc herniation occurs when the inner portion of a spinal disc pushes through the outer layer of the disc. If the herniated material irritates or compresses a nearby nerve root, it may cause radiating pain, numbness, tingling, or weakness.
Yes. “Slipped disc” is a common term for a herniated disc, although the disc does not truly slip out of place. The term usually refers to disc material pushing outward and potentially irritating nearby nerves.
A bulging disc usually means the disc extends outward more broadly. A herniated disc usually means a more focal area of disc material has pushed through the outer disc layer. Both can be seen on MRI, and either may or may not cause symptoms depending on nerve involvement and clinical context.
Yes. A lumbar disc herniation can irritate or compress a nerve root and cause sciatica-like symptoms, including pain that travels from the lower back or buttock into the leg or foot. Symptoms may include burning, electric pain, numbness, tingling, or weakness.
Yes. A cervical disc herniation can irritate a nerve root in the neck and cause pain that travels into the shoulder, arm, hand, or fingers. This may be accompanied by numbness, tingling, weakness, or changes in reflexes.
Yes. Numbness, tingling, pins and needles, or weakness can occur when a disc herniation affects a nerve root. Weakness, progressive numbness, foot drop, or loss of bowel or bladder control requires urgent medical evaluation.
Yes. Some disc herniations are found incidentally on MRI and do not cause symptoms. This is why MPM correlates imaging with symptoms, physical exam findings, neurologic signs, and functional limitations before deciding whether the disc is the likely pain generator.
A diagnosis-first evaluation looks at the pain pattern, neurologic findings, imaging, movement triggers, strength, sensation, reflexes, and overlapping conditions. Similar symptoms can come from spinal stenosis, SI joint dysfunction, facet arthropathy, spondylolisthesis, inflammatory arthritis, hypermobility, peripheral nerve entrapment, or chronic pain sensitization.
Yes. In patients with hypermobility or EDS, spine pain may involve joint instability, ligament strain, muscle guarding, SI joint dysfunction, facet irritation, nerve sensitivity, and altered biomechanics. A disc herniation may be one part of a larger pain pattern.
Yes. Inflammatory back pain from conditions such as seronegative spondyloarthropathy or autoimmune-related pain may overlap with mechanical spine pain. Morning stiffness, pain that improves with movement, SI joint inflammation, enthesitis, fatigue, or systemic symptoms may suggest an inflammatory contributor.
Treatment depends on the symptoms and clinical findings. Options may include activity modification, rehabilitation coordination, medication management, acupuncture, Feldenkrais, biofeedback, pain psychology, epidural injections, spine injections, steroid injections, or surgical referral when there is severe or progressive neurologic compromise.
Epidural injections may be considered when a disc herniation is causing nerve root irritation, radicular pain, sciatica, arm pain, or leg pain that has not improved enough with conservative care. They are selected based on the pain pattern, imaging, exam findings, and overall risk profile.
Spinal cord stimulation or dorsal root ganglion stimulation may be considered in selected chronic nerve pain cases, especially when pain persists despite appropriate conservative, interventional, or surgical evaluation. These options are not routine treatments for every disc herniation.
Surgical evaluation may be appropriate when there is progressive weakness, severe nerve compression, disabling symptoms that do not improve with non-surgical care, or urgent neurologic concerns. MPM coordinates surgical referral when the clinical picture suggests it may be needed.
Urgent evaluation is needed for new or worsening weakness, foot drop, loss of bowel or bladder control, saddle anesthesia, progressive numbness, severe trauma-related back pain, fever, unexplained weight loss, history of cancer, severe unrelenting night pain, infection risk, or rapidly worsening neurologic symptoms.
Before care begins, our team helps patients understand the practical side of treatment, including insurance verification, out-of-network benefits, cost-share estimates, self-pay options, and billing questions. We believe patients should have as much clarity as possible before moving forward.
If you have an MRI showing a disc herniation or symptoms such as sciatica, radiating arm or leg pain, numbness, tingling, weakness, neck pain, or back pain, MPM can help determine whether the disc is the true pain generator. Our diagnosis-first approach evaluates your symptoms, exam findings, imaging, neurologic status, hypermobility context, inflammatory pain risk, and overlapping spine or SI joint contributors before recommending treatment.
A disc herniation occurs when the inner portion of a spinal disc pushes outward through the outer disc layer. Spinal discs sit between the vertebrae and help absorb load, support movement, and create spacing between the bones of the spine. When disc material herniates, it may irritate nearby nerve roots and cause radiating pain.
Disc herniations most often affect the lumbar spine in the lower back or the cervical spine in the neck. A lumbar disc herniation may cause lower back pain, buttock pain, sciatica, leg pain, foot pain, numbness, tingling, burning, or weakness. A cervical disc herniation may cause neck pain, shoulder pain, arm pain, hand symptoms, numbness, tingling, or weakness.
Not every disc herniation is painful. Some disc herniations are found on MRI in patients whose symptoms come from another source. This is why MPM evaluates disc herniations through a diagnosis-first model rather than treating the MRI report alone.
A herniated disc usually refers to disc material pushing outward through a weakened or torn area of the outer disc. A bulging disc usually refers to a broader outward extension of the disc. Degenerative disc disease refers to age-related or wear-related changes in the disc, including disc height loss, dehydration, or structural change.
These terms can sound alarming, but they are not always the same as a pain diagnosis. A bulging disc, herniated disc, or degenerative disc finding may be clinically important when it matches the patient’s symptoms and exam. It may be less important when the finding does not match the pain pattern.
Symptoms depend on the location of the herniation and whether a nerve root is irritated or compressed. Some patients have localized neck or back pain. Others have radiating pain into the arm or leg.
Lumbar disc herniations may cause sciatica, buttock pain, leg pain, foot pain, numbness, tingling, burning, pins and needles, or weakness. Cervical disc herniations may cause neck pain, shoulder pain, arm pain, hand symptoms, numbness, tingling, grip changes, or weakness.
Pain may worsen with sitting, bending, lifting, coughing, sneezing, twisting, or certain positions. Some patients feel better when standing or lying down. Others have symptoms that change throughout the day.
Sciatica is a symptom pattern, not a diagnosis by itself. It usually refers to pain that travels from the lower back or buttock down the leg. A lumbar disc herniation is one common cause of sciatica, especially when disc material irritates a nerve root.
Sciatica-like pain can also come from spinal stenosis, spondylolisthesis, sacroiliac joint dysfunction, piriformis-region irritation, hip pathology, peripheral nerve entrapment, pelvic nerve irritation, inflammatory spine disease, or chronic pain sensitization.
This distinction matters because the best treatment depends on the actual pain generator.
A lumbar disc herniation may affect nerve roots that travel into the buttock, thigh, calf, foot, or toes. Symptoms may follow a nerve distribution and may include sharp pain, burning pain, electric pain, numbness, tingling, or weakness.
A careful neurologic exam helps determine whether the symptoms match the disc level seen on MRI. MPM evaluates strength, sensation, reflexes, pain location, movement triggers, and imaging findings to determine whether the disc herniation is likely responsible.
A cervical disc herniation may irritate a nerve root in the neck and cause symptoms into the shoulder, arm, hand, or fingers. Patients may describe radiating pain, pins and needles, numbness, tingling, weakness, or changes in hand function.
Neck pain with arm symptoms may also overlap with cervical facet pain, shoulder disorders, thoracic outlet syndrome, peripheral nerve entrapment, cervical dystonia, inflammatory disease, or complex pain mechanisms. MPM evaluates these possibilities when symptoms do not point clearly to one source.
MRI is useful, but it is only one part of the diagnostic process. A disc herniation may be incidental if it does not match the patient’s symptoms, neurologic exam, or pain distribution.
For example, a patient may have a lumbar disc herniation on MRI but pain that is actually coming from the SI joint, facet joints, hip, peripheral nerve, or inflammatory arthritis. Another patient may have a cervical disc herniation but symptoms more consistent with shoulder pathology or thoracic outlet syndrome.
MPM’s approach is to ask whether the imaging finding explains the patient’s actual lived symptoms.
In patients with hypermobility or Ehlers-Danlos syndrome, spine pain can be more layered. Joint instability, ligamentous laxity, muscle guarding, recurrent sprains, SI joint dysfunction, facet irritation, altered mechanics, and nerve sensitivity may all contribute.
A disc herniation may still be relevant, but it may not be the only driver. Patients with hypermobility may need care that considers stabilization, movement patterns, joint protection, myofascial guarding, and overlapping pain generators.
MPM evaluates disc herniations in this broader context, especially when pain is recurrent, multi-site, or not fully explained by imaging.
Inflammatory back pain can sometimes be mistaken for mechanical disc pain. Conditions such as seronegative spondyloarthropathy, autoimmune-related pain, enthesitis, rheumatoid arthritis, Sjogren’s, and inflammatory arthritis may contribute to back, neck, SI joint, tendon, or joint pain.
Features that may raise suspicion include prolonged morning stiffness, pain that improves with movement, pain that worsens with rest, SI joint inflammation, tendon attachment pain, fatigue, eye inflammation, psoriasis, bowel symptoms, or a personal or family history of inflammatory disease.
MPM evaluates whether symptoms appear mechanical, inflammatory, nerve-root-related, instability-related, centrally amplified, or mixed.
MPM’s evaluation includes symptom mapping, physical exam, neurologic screening, imaging review, prior treatment review, and assessment of overlapping musculoskeletal or inflammatory contributors.
The goal is to determine whether the patient’s symptoms are most consistent with disc-related nerve irritation, facet-mediated pain, SI joint dysfunction, spinal stenosis, spondylolisthesis, inflammatory back pain, hypermobility-related instability, myofascial pain, peripheral nerve irritation, or chronic pain sensitization.
This process helps avoid unnecessary procedures and helps select treatments that match the actual clinical pattern.
Many disc herniation symptoms can be managed without surgery when there is no urgent neurologic concern. Treatment may include activity modification, rehabilitation coordination, medication management, acupuncture, Feldenkrais, biofeedback, pain psychology, and carefully selected interventional options.
The plan depends on pain severity, nerve symptoms, neurologic findings, functional limitation, prior treatment response, and patient goals.
Epidural injections may be considered when a disc herniation is causing nerve root irritation, sciatica, cervical radicular pain, or persistent radiating symptoms. These injections are intended to reduce inflammation around irritated nerve roots and may also help clarify the pain generator in selected cases.
Other spine procedures, such as epidural lysis of adhesions, may be considered in selected patients with persistent radicular pain, prior procedures, scarring, or complex spine pain patterns. These options require careful diagnosis, imaging review, risk discussion, and clinician supervision.
Spinal cord stimulation or dorsal root ganglion stimulation may be considered for selected patients with persistent neuropathic pain that has not improved despite appropriate conservative, interventional, or surgical evaluation. These treatments are not routine for every herniated disc and are typically considered only after careful assessment.
Neuromodulation does not remove a disc herniation. It is considered for selected chronic nerve pain patterns when the treatment goal is pain modulation and functional improvement.
Surgical evaluation may be needed when there is progressive weakness, severe nerve compression, disabling pain that does not improve with appropriate non-surgical care, or neurologic compromise.
Urgent medical evaluation is needed for new or worsening weakness, foot drop, loss of bowel or bladder control, saddle anesthesia, progressive numbness, severe trauma-related back pain, fever, unexplained weight loss, cancer-related red flags, severe unrelenting night pain, infection risk, or rapidly worsening neurologic symptoms.
These symptoms may indicate serious neurologic, infectious, inflammatory, traumatic, or structural conditions that require timely care.
MPM approaches disc herniations with clinical restraint and diagnostic precision. A herniated disc is not automatically a surgical problem, and it is not always the pain source. But when a disc herniation does match the patient’s symptoms and neurologic findings, it deserves careful, structured treatment planning.
For patients searching for herniated disc treatment in NYC, MPM evaluates the full pain picture: MRI findings, symptoms, exam findings, nerve involvement, spine mechanics, hypermobility, inflammatory back pain risk, SI joint and facet overlap, prior treatment response, and chronic pain mechanisms.
The result is a staged care plan designed around the actual pain generator rather than the imaging label alone.
