Have you been diagnosed with a spinal disc herniation in your low back? Lumbar disc herniations may cause severe low back pain, which may motivate you to seriously consider back surgery. While surgery such as discectomy has been shown to be pretty effective, waiting it out with the help of physical therapy (for about a year) may be another viable treatment option. Deciding between surgery or more conservative back pain treatment for your disc herniation is best done by consulting with your doctor.
Conservative treatment for a lumbar herniated disc may include rest; taking pain medication, muscle relaxers and/or anti-inflammatory medications; having an epidural steroid injection (to reduce inflammation and leg pain); and/or physical therapy. Generally, the aim of conservative care is to reduce the pain from irritated nerve root(s) and to get you in better shape. Conditioning your muscles may help protect your back and enable you to do more with less pain.
While rest is recommended, too much of it may cause your muscles to stiffen up or get weak. This will make doing the exercises given in physical therapy (or by your doctor) that much more difficult to accomplish. As exercise is one of the best ways to manage or even overcome back pain, being ready, willing and able to participate will likely prove to be a crucial element of your healing.
Medication for a Herniated Disc In Your Low Back
Your doctor may prescribe pain medication, muscle relaxers, and/or anti-inflammatory medications. A small percentage of doctors even prescribe opioids for acute back pain due to a herniated disc. Some medications only relieve pain, while others provide more than one benefit.
For example, NSAIDs, otherwise known as anti-inflammatories, reduce swelling and pain. Reducing swelling early on in your treatment can help you later in your healing, since swelling generally turns into scar tissue, which limits range of motion. When a lot of scar tissue is present, you’ll have to do extra work to get back to optimal functioning.
Taking a muscle relaxer may enable you to exercise with less tension and muscle pain, and help you progress in physical therapy.
Approximately 3% of all back pain patients are prescribed opioids, a type of narcotic pain reliever. A study from Dartmouth found that people with herniated discs tend to get opioid prescriptions more often than people with any other type of back problem. However, a 2007 review published in the Annals of Internal Medicine found that about 24% of patients who take opioids for back problems develop bad habits around taking medicine, including substance abuse.
Physical Therapy for Lumbar Disc Hernation
Physical therapy treatments for a lumbar herniated disc may include hot or cold packs, traction to increase the disc space and take pressure off the nerve root, manual (“hands on”) therapy, electrical stimulation and/or ultrasound, and back exercises.
Lower Back Exercise Therapy
Exercise therapy usually starts immediately upon diagnosis of your herniated disc. It may begin gently with pelvic tilts, glute bridges, and stretches, and proceed to more vigorous exercise once your pain decreases. Of course, chances are excellent you’ll get a home exercise program, especially if you go to physical therapy for your disc herniation. Don’t skip this step in your healing; exercise has been shown time and time again to be one of the most effective ways to manage back pain.
Some clinics offer work conditioning programs for people with chronic back pain. A work conditioning program may help prepare you for your specific job tasks through exercise and education about body mechanics. A work hardening program takes this further by actually simulating your work activities right there in the clinic, though not every physical therapy office offers work hardening.
Generally, conservative treatments such as the ones mentioned above are tried for 6 weeks in cases of a herniated disc. If the conservative approach fails to significantly relieve the pain or other symptoms, your doctor may suggest having a discectomy.
Herniated Intervertebral Disk. MD Consult. Accessed Aug 2010.
Martell, B. MD, MA. et. al. Systematic Review: Opioid Treatment for Chronic Back Pain: Prevalence, Efficacy, and Association with Addiction. Annals of Internal Medicine. Jan 16 2007. Accessed Sept 2010. http://www.annals.org/content/146/2/116.abstract
Rose, R. MD, et. al. An Observational Study on the Prevalence and Pattern of Opioid Use in 25,479 Patients With Spine and Radicular Pain. SPINE Volume 27, Number 2, pp 201–205. Accessed Sept 2010. http://www.dartmouth.edu/sport-trial/Related_Papers/FanciulopiodsSpn27_02.pdf