Week 1–2: the disc unloads, pain starts to centralise
The first phase is about reducing pressure inside the disc so the outer wall can recoil and the inflamed nerve root gets breathing room. Sessions run three times a week. Class 4 laser is usually added over the nerve root because most of the pain in the first fortnight is chemical inflammation rather than mechanical pressure.
The marker we look for is not less pain — it is pain that moves. Sciatica that reached the calf now stops at the thigh. Arm pain that reached the fingers stops at the elbow. That is centralisation and it is the strongest early predictor of a good outcome.
Week 3–5: intensity drops and function returns
Once the referred pain has retreated, intensity falls. Patients typically report sitting tolerance rising from ten minutes to forty, being able to drive again, and sleeping through the night. This is also where we introduce loading — the disc needs graded stress to remodel, and rest beyond this point starts to work against you.
Week 6–8: rehabilitation decides whether it lasts
Decompression buys the disc a window. What fills that window determines whether you are back in a year. Deep stabiliser retraining with super-inductive therapy, hip and thoracic mobility, and correcting the sitting or lifting pattern that loaded the disc in the first place are what convert short-term relief into a durable result.
Signs the protocol is not working — and needs changing
- No centralisation at all after 6 sessions
- Pain travelling further down the limb rather than retreating
- New or increasing weakness in the foot, hand or grip
- Night pain that is unrelated to position
- Any bladder, bowel or saddle-area change — this is an emergency
What slows the timeline down
Sequestered fragments, multi-level disease, diabetes-related nerve healing, smoking, and symptoms present for over two years all extend the course — often to 20–24 sessions. Conversely, an acute first-episode contained bulge in a patient under 40 frequently responds in 8–10 sessions.
