Spine

Herniated and bulging discs.

A disc on a scan is not automatically the cause of your pain. Establishing whether it is changes what should be done about it.

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What a disc herniation is, and is not

Discs sit between the vertebrae and absorb load. When the tough outer ring weakens, the softer centre can push outward — a bulge — or through it entirely — a herniation. If that material contacts a nerve root, the result is pain, numbness or weakness travelling along that nerve.

Here is the part that matters: disc bulges are found routinely on the MRIs of people with no pain at all, and the proportion rises with age. A disc reported on your scan is a candidate explanation, not a verdict. Whether it is your explanation depends on whether the level it sits at matches the symptoms you actually have.

The other thing worth knowing: herniated discs often shrink on their own over months. Treatment is frequently about managing the inflammation and pain well enough to let that happen, rather than about removing the disc.

What we see

Signs a disc is genuinely involved

  • Pain travelling along a specific nerve path, not just localised back pain
  • Numbness or tingling in a defined band of skin
  • Weakness in muscles supplied by that nerve root
  • Pain worse with sitting, bending forward, coughing or sneezing
  • Symptoms matching the level shown on imaging

How it works

How we handle it

  1. 01

    Match symptoms to level

    Your examination should predict what the MRI shows. When it does, the diagnosis is solid. When it does not, we keep looking.

  2. 02

    Manage the inflammation

    Much of the pain of a herniation is chemical inflammation around the nerve, not just mechanical pressure — which is why targeted anti-inflammatory treatment can help substantially.

  3. 03

    Buy time for healing

    The aim is to control pain well enough for you to stay active while the herniation resorbs, which most do.

  4. 04

    Escalate only if needed

    Progressive weakness or intractable pain despite proper treatment is when a surgical opinion is genuinely warranted. Most people never reach that point.

Treatment options

Epidural steroid injection

Anti-inflammatory medication delivered under live X-ray to the specific level and side involved.

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Selective nerve root block

Confirms the level responsible and often relieves the pain at the same time.

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Regenerative therapy

For contributing degenerative change in the surrounding structures.

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Spinal cord stimulation

For persistent nerve pain, including after previous disc surgery.

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In their words

Patients treated for this

5.0 from 217 Google reviews
★★★★★
Over too many years I have seen too pain management guys. This one is different. First, he caught something on an MRI that only one other health professional had caught, including those reading the MRI, a cyst at the base of my spine pushing again the nerve. Second, his (their) treatment of it was first class. He took his time, was gentle. Concerned about my pain level throughout the process. Talked. Was funny, or at least amused by my jokes, a nervous habit and caring. Great experience!
Jim McCarthy
★★★★★
My first visit with the "Ponte Vedra Spine & Pain Center" was "exceptional". The staff were very friendly & welcoming as well as professional. My meeting with Dr Loch was equally "exceptional." He carefully reviewed the MRIs & and evaluations of previous physicians, listened attentively while I reported the origins of my back problem through my current condition. He then fully explained the available procedures to treat my back pain & was very frank about how effective each procedure could be in alleviating my pain. Our visit concluded with a thorough plan to address my condition until our next meeting; Dr Loch prescribed medication to manage my pain, and set up a follow up appointment. I could not be more impressed with the Spine & Pain Center and happier with my decision to seek treatment with Dr. Loch & staff. J. B. Egan CAPT. USCR Ret.
Joseph Egan
★★★★★
The Team at PV Spine and Pain have been great. From initial reach out through completion of procedure and communication has been top notch. Dr. Loch took time to discuss my needs, answered my questions and is unquestionably is an expert in his field. It is a friendly environment with the staff that clearly is concerned with the patient’s well-being.
Jeremiah White
Read all reviews on Google → Synced from Google on 24 July 2026

Questions we get asked

Can a herniated disc heal without surgery?
Frequently. The body reabsorbs herniated disc material over months, and the majority of people improve without an operation. Treatment is often about controlling pain and inflammation well enough to let that process run.
My MRI says degenerative disc disease. How bad is that?
It sounds far more alarming than it is. It describes normal age-related change in the discs, and it is present in most people past middle age including plenty who have never had back pain. It is a description, not a diagnosis of your pain.
Should I avoid lifting and exercise?
Prolonged rest tends to make things worse, not better. What you should avoid is specific loading that provokes your symptoms. We will be specific about what that means for you rather than telling you to stop moving.

Eliminate pain and reclaim your life.

Request an appointment with Dr. Loch, or call the office at (904) 750-3787. Most patients are seen within a week.

Request an appointment