Why do you need an MRI before treating sciatica?
An MRI is the only way to see whether your sciatica is coming from a disc, and how far that disc has pushed out. Without it, you are guessing. Every treatment decision after that is a guess too.
Listen, most people with sciatica get handed a treatment plan before anyone has actually looked at the disc. They get pills. They get stretches. They get a home exercise sheet. Nobody ever confirmed what is pressing on the nerve.
When we pull up this patient’s MRI and count the levels, L5, L4, L3, L2, we can see the extrusion at L4-L5 sitting right where the nerve exits. That is not a theory. That is a picture. Now we know what we are treating and we know exactly which level to target.
The MRI is also how we prove whether the treatment worked. We take a post-MRI at the end. Not “how do you feel,” not “rate your pain one to ten.” An actual image, measured against the first one.
What is an L4-L5 disc extrusion?
An extrusion is when the soft center of the disc pushes all the way through the outer wall and sits outside the disc space. At L4-L5 it commonly lands on the nerve that runs down the leg into the foot.
Think of the disc like a jelly-filled donut. The annulus is the dough, the nucleus is the jelly. A bulge is the dough pushing out. A herniation is the jelly starting to spit out. An extrusion is the jelly out and sitting on the nerve.
That is why the symptoms are so specific. This patient’s three complaints are textbook: sciatica, a numb foot, and a life that shrank down to almost nothing because he cannot be active anymore.
What is the difference between a disc bulge, a herniation, and an extrusion?
They are three stages of the same problem. A bulge is the disc wall pushing outward. A herniation is the inner material starting to push through that wall. An extrusion is that material all the way out and sitting in the canal.
Go back to the jelly-filled donut. A bulge is the dough swelling out around the whole edge. It is common, it shows up on plenty of MRIs, and by itself it often causes nothing at all. A herniation is the jelly starting to spit out through a weak spot in the dough. An extrusion is the jelly out, sitting where it does not belong, usually right on top of a nerve.
Listen, this distinction matters because the words on your MRI report drive what happens next. Patients get told “you just have a bulge” and go home with a stretching sheet. Patients get told “you have an extrusion” and get sent to a surgeon. Neither is automatically correct. The report has to be correlated to your exam and your actual symptoms.
There is a fourth term you may see: sequestration. That is when a piece of the disc breaks completely free of the parent disc and migrates up or down the canal. In our published case series, one patient had 18 mm of that migrated material above the L2-L3 disc.
What does a numb foot mean when you have sciatica?
Numbness means the nerve is not just irritated, it is being compressed enough to lose function. That is a signal to get imaging and get moving on a real plan, not to keep waiting it out.
Pain is the nerve complaining. Numbness is the nerve going quiet. Patients describe the leg being on fire, or toes that feel achy like little critters, or a foot that just is not there when they put weight on it.
The other thing patients describe is the urge to move the leg constantly. Wanting to kick your leg through the door at two in the morning because nothing you do makes it settle. If this is you, you know what I’m talking about.
Watch for weakness separately from numbness. Trouble lifting the front of your foot, catching your toe on stairs, or a foot that slaps when you walk means the motor side of the nerve is affected, not just the sensory side. That moves the timeline up.
Anyone in Walnut Creek or the East Bay with sciatica plus numbness should have an MRI in hand before they accept another round of the same treatments.
Why don’t medications, physical therapy, and exercises fix a disc extrusion?
Because none of them target the disc. Medications quiet the pain signal. Physical therapy and exercise work the muscles around the spine. The extrusion itself is untouched, so the nerve stays compressed.
This patient did everything he was told. Medications, physical therapy, exercises. Months of effort. It failed for one reason: the thing causing the problem was never addressed.
The missing factor is compression. Until the pressure inside that disc changes, the jelly has no reason to go anywhere. You can strengthen your core all day. The extrusion does not care.
Same story with cortisone. A shot is a chemical solution for a physical problem. It can dial down the inflammation for a few weeks, and I am glad when it buys someone relief, but it does not move the disc off the nerve.
Can spinal decompression actually reduce a disc extrusion?
Yes, and it is measurable on a post-treatment MRI. In our peer-reviewed case series published in the Journal of Contemporary Chiropractic, all four patients had a measurable reduction in herniation index, recovered fully from their pain, and avoided surgery. In one case the migrated disc fragment reduced by 78%.
You can read the full paper here: Reduction of the Size of a Lumbar Disc Herniation Using Non-Surgical Spinal Decompression Combined With Chiropractic Care (Dudum J, Gatterman B. JCC. 2024;7(1):146-155).
That is the part that matters. Not a survey. Not a satisfaction score. Before-and-after MRIs, measured by a radiologist, showing the herniation smaller and off the nerve.
Here is how non-surgical spinal decompression works. It creates negative pressure inside the disc. Think about an airplane cabin at 10,000 feet. Change the pressure and everything inside changes with it. That pressure change is what pulls the jelly back toward center and takes the load off the nerve.
Why does the angle of the decompression table matter so much?
The angle determines which disc level the pull actually reaches. Set it wrong and you are treating the wrong segment. We adjust in 2.5 degree increments based on the level and the direction the disc migrated.
For an L4-L5 extrusion, the angle is not a rough guess. It is not 11 degrees. It is not 14 degrees. It is a specific number, and it changes depending on whether the disc migrated up or down.
Angle is only one of three dials. Weight is the second. The textbook says 50% of body weight and I think that is flawed, way too aggressive. We start low and build. Oscillation is the third, the pull-and-relax accordion cycle that separates real decompression from generic traction.
Decompression tables are Ferraris. Incredible machines. But you have to know how to drive stick or you crash. That is why two patients on the same table can get completely different results.
Can a disc extrusion heal on its own?
Sometimes, yes. The body can reabsorb extruded disc material over months or years. The question is whether you can function during that window, and whether the nerve is being damaged while you wait.
I am not going to tell you every disc needs treatment. Some resolve. But “wait and see” is a strategy, not a plan, and it is a bad strategy when you have numbness, weakness, or a life that has shrunk down to nothing.
The patient in this video waited. He tried medications, physical therapy, and exercises across months. His foot went numb anyway. Time alone was not fixing the compression.
The other issue with waiting is that nobody measures anything. If you have no post-MRI, you have no idea whether you got better or just got used to it.
When is surgery actually necessary for a disc extrusion?
Some situations are surgical and you should not delay. Loss of bowel or bladder control, numbness through the groin or saddle area, or rapidly progressing weakness in both legs are emergencies. Go to the emergency room, not to a chiropractor.
My whole mission is helping people avoid unnecessary spinal surgery. Unnecessary. That word does a lot of work. There are surgeries that need to happen, and there are surgeons I trust and refer to.
What I fight is the conveyor belt. Online physical therapy, then a cortisone shot, then a spot on the surgery waitlist, without anyone ever addressing the compression itself. That is the path most patients get put on, and it is the reason so many of them end up in my office asking why nobody told them this option existed.
If you have red flag symptoms, get emergency care. If you have pain, sciatica, and numbness that has been dragging on without progress, you have room to try something that targets the disc first.
Why do I still have pain after back surgery?
Because surgery removes the disc material but does not change the pressure that pushed it out. The compression is still there. About 25% of the patients in my program have already had spinal surgery.
This is the part that surprises people. They had the procedure, the fragment came out, and six months or two years later the pain is back. They assume they failed the surgery. They did not. The surgery addressed the symptom, not the mechanism.
The jelly came out for a reason. If nothing changed the load and the pressure inside that disc, the same thing tends to happen again, at the same level or the one next to it.
Post-surgical patients need a careful review before decompression, and not everyone is a candidate. Hardware, fusions, and the specifics of what was done all factor in. That is a conversation with your imaging in hand, not a yes or no over the phone.
What does a spinal decompression session actually feel like?
Most patients describe it as a slow, comfortable stretch, not pain. You lie on your back on the table in a harness while the machine pulls and releases in cycles. Sessions run 20 to 30 minutes.
The pull-and-release is the part people do not expect. It is not a constant yank. The table applies tension, holds, then eases off, then applies it again, like an accordion. Sensors read when your muscles resist and back the tension off before you can guard against it.
In our published protocol the hold-to-rest ratio was 1 to 1, with the tension dropping 10% to 50% during the rest phase. So a patient pulling at 60 pounds holds at 60 for 30 seconds, drops into a range between 54 and 30 pounds for 30 seconds, then comes back to 60. That cycle is what lets us get real decompression without triggering a spasm.
Compare that to an inversion table, where you just hang. No cycle, no sensors, no control. That is exactly why people spasm on them.
How is this different from an inversion table or traction?
An inversion table is just hanging. There is no oscillation and no control, which is why so many people spasm on one. Decompression is computer-controlled pull and release aimed at a specific disc level.
I get asked this constantly, because inversion tables are cheap and they are everywhere. Hanging upside down does stretch you. It does not create the sustained, targeted negative pressure inside a single disc that shows up as a reduction on a post-MRI.
How do I know if I am a candidate for spinal decompression?
It comes down to three things: what your MRI actually shows, whether your symptoms match those findings, and whether you have any red flags that make you surgical instead. You cannot answer that from a website.
Number one, the imaging. We need to see the level, the type of lesion, and the direction the material migrated. That determines the entire protocol.
Number two, the correlation. An MRI does not equal pain. An MRI is a static picture of you lying still. Plenty of people walk around with findings on film and no symptoms at all, and the reverse happens too. We match the image to your exam and your history before we decide anything.
Number three, the honest no. Not everybody is a candidate. Some patients need a surgeon and some need something else entirely. Telling someone that up front is part of the job.
Where can I get spinal decompression in Walnut Creek, CA?
Dudum Chiropractic at 1900 Olympic Blvd, Suite 100, Walnut Creek, CA 94596 is a dedicated non-surgical spinal decompression center with 13 decompression tables and more than 51,000 treatments performed. We review your MRI, correlate it to your exam, and tell you honestly whether you are a candidate. Call (925) 300-3302.
We see patients from Walnut Creek, Lafayette, Concord, Pleasant Hill, Danville, Alamo, and across Contra Costa County and the East Bay, and people fly in from around the world for this. About 300 patients a week come through our doors.
If you are searching for spinal decompression near Walnut Creek, ask the clinic you are considering two questions before you book. How many decompression tables do they run, and can they show you a post-treatment MRI. Most cannot.
I went through this myself. L5-S1 herniation at 35 years old, ten years into practice, and nothing I knew how to do touched it. I know what hopeless feels like, because that is exactly where I was. My job now is to give you hope and a plan that actually targets the disc.
Quick questions, straight answers
Can an L4-L5 disc extrusion heal without surgery?
Yes, in many cases. Our published case series documented herniation index reductions of 9.4%, 16.5%, 29.1%, and 29.5% on follow-up MRI, with all four patients fully recovered from pain and no surgery. In the 16.5% case, the migrated fragment above the disc reduced by 78%. Results depend on the size, location, and age of the extrusion, which is why the MRI review comes first.
How long does spinal decompression take to work?
Most patients start noticing changes within the first few weeks. In our published case series, patients completed 20 to 30 decompression sessions over 8 to 10 weeks, and the follow-up MRI was taken four to six months after treatment ended. Larger extrusions can take longer.
Does a numb foot from sciatica go away?
It often does once the pressure comes off the nerve. Numbness that has been present for a long time can take longer to recover than pain. That is one reason not to wait months hoping it resolves on its own.
Can I still get decompression if I already had back surgery?
Often yes. About 25% of the patients in my program have already had spinal surgery. Surgery removes the material but does not fix the compression, which is why symptoms can return. We review the operative history and imaging before deciding.
Does spinal decompression hurt?
Most patients describe it as a comfortable stretch rather than pain. The table pulls and releases in cycles, and sensors reduce the tension when your muscles resist, which is what prevents the spasming people get on inversion tables. Sessions run 20 to 30 minutes.
How many decompression sessions will I need?
In our published case series, patients completed 20 to 30 sessions over 8 to 10 weeks. Your number depends on the size and type of the lesion and how you respond, which is why the plan is set after the MRI review rather than before it.
Is spinal decompression covered by insurance?
Coverage varies widely by plan and many carriers do not cover it. Call our office at (925) 300-3302 and we will walk you through the specifics for your situation before you commit to anything.
Where can I get spinal decompression in Walnut Creek, CA?
Dudum Chiropractic, 1900 Olympic Blvd, Suite 100, Walnut Creek, CA 94596. Call (925) 300-3302 and we will review your MRI and let you know if you are a candidate. We also serve patients from Lafayette, Concord, Pleasant Hill, Danville, and throughout Contra Costa County.
If you’re dealing with back pain and want to find out whether you’re a candidate for spinal decompression, contact us at Dudum Chiropractic in Walnut Creek or call (925) 300-3302. You deserve relief without spinal surgery.